科研之友
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摘要
At this time of dynamic changes in the U.S. health-care system, the emergency department (ED) has a unique vantage point from which to monitor the pulse of Americans' health and to ensure that vulnerable groups are not the victims of unintended consequences of policy and system changes. The ED has a vital, pluripotent role in the U.S. health-care system: It is a primary site of acute unscheduled care and the chief source of hospital admissions, it serves as a diagnostic center, and it is an essential strand of federal, state, and community safety nets.' With such an array of roles, the ED forms a key intersection, where clinical, social, and financial issues converge and often bottleneck. At this privileged but pressurized site, the ED is a place where early effects of policy changes may be detected, diagnosed, and addressed. Yet, the opportunity for the ED to serve this monitoring function is frequently missed. Development of a coordinated network of EDs acting as monitoring points would leverage the natural, timely advantage of the ED and its unique position in the U.S. health-care system. High-yield opportunities for taking a pulse on how our system is caring for its most vulnerable patient groups might be found in tracking ED utilization patterns, rates of left-without-being-seen patients, ED revisit rates, and rates of psychiatric boarding. By monitoring these indicators in real time, system-level alerts can capitalize on the convergence and magnification of issues in the ED by collecting data that are relevant on many levels for hospitals, health systems, and local, state, and national jurisdictions. Such a system could illuminate key issues, inform innovative solutions, and provide opportunities for early intervention.
- 出版日期2015-10
