Noteworthy Emergency Medicine Advancements: A 20-Year Review

Robert D. Glatter, MD

Disclosures

May 27, 2015

Rapid Adoption of Ultrasound in Emergency Medicine Training and Practice

Of all the improvements in the practice of emergency medicine (EM) during the past two decades, the advent of ultrasound has probably had the greatest impact on our ability to more rapidly and accurately triage patients presenting to the emergency department (ED). The integration of ultrasound into the practice of EM has significantly improved and revolutionized the way we evaluate, treat, and make dispositions for patients, allowing a dramatic shift in the management of patients.

Ultrasound has enabled EM practitioners to more rapidly and accurately diagnose life-threatening conditions‎, thereby expediting treatment to reduce the risk for complications and death. Ultrasound in the ED has also facilitated ongoing care for patients with rapidly changing vital signs who require immediate treatment.

Of note, the use of ultrasound has enhanced patient safety by allowing invasive procedures to be accomplished more easily. For example, this technology permits central lines to be placed more accurately—even peripherally—in situations where standard approaches might not succeed. Ultrasound increases the safety of many other procedures (eg, paracentesis, thoracentesis, and lumbar puncture), reducing the risk for complications.

The Internet, and Rise of the Smartphone Apps

The ability to rapidly access medical information, relevant images, and published literature using the Internet has paved the way for EM clinicians to provide more integrated and expedited care for patients, especially in remote settings.

This rapid access to information—further enhanced by early adoption of smartphones with specialized apps—has enhanced access to critical information for patient care in the ED.

Furthermore, the ability to communicate with practitioners on such social media platforms as Twitter, as part of the FOAM (Free Open Access Meducation) movement, allows the instant exchange of ideas and information, which has the potential to make a positive impact on patient care and management.

Other modes of sharing information through such websites as Figure 1 for sharing medical images, provide opportunities for teaching and the dissemination of information on a large scale, greatly enhancing educational potential.

Telemedicine

With technology involving streamed video, a consultant can provide input to patient care in a more expedited fashion, helping to make more accurate determinations about such conditions as stroke, dermatologic disease, and mental health issues. These video encounters can then help to determine the need for further specialty care, or the transfer of a patient to a higher level of care. Evaluating stroke symptoms, assessing the need for thrombolytic therapy, and making the decision to transfer a patient can all be influenced by telemedicine consultation with a neurologist.

Psychiatric care is another area that benefits from such technology. Treatment dispositions can be facilitated, especially in more rural settings where a psychiatrist or mental health professional may not be readily available.

Furthermore, newer live-streaming video apps, such as Periscope integrated into Twitter—can potentially be useful in the rapid and immediate evaluation of patients in remote settings if the data can be encrypted to be HIPAA compliant.

Freestanding Emergency Departments

The rapid growth of freestanding EDs in the past decade is changing how EM is practiced in some states. Texas, especially, has seen explosive growth in these facilities, which give patients a new way to access the healthcare system for emergency care. The new trend is also increasing the options for EM physicians in terms of available practice settings.

Economics are another important aspect and determinant affecting the growth of this sector, ultimately changing the competitive landscape for patients requiring emergency care.

The competition for patients (who now have options beyond the traditional ED located within a hospital) has the potential to force change in how hospitals market themselves to patients for emergency care.

The implementation of this new model also has the potential to affect reimbursement for care—in light of new bundled care approaches moving away from fee-for-service—as insurers take note of this streamlined and economically motivated approach to care.

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