If you could build an EM system from scratch…

…what would you do differently? 

This blue sky question is part of the reason that more than a thousand emergency physicians gathered in San Francisco this week. Every country is at a different stage of EM development, but some have a relatively clean slate to work with. Take Dr. Jim Holliman for instance, the man in charge of EM development in the entire country of Afghanistan. Not only does Dr. Holliman have the chance to help a country start fresh with their EM strategy, he’s here at ICEM hearing lessons-learned from more than 60 country delegates. In theory, someone like Holliman should be able to pick and choose the best elements of every system. Of course, that’s putting it way too simply (particularly considering the physical danger inherent in many regions), but it brings up an interesting question that I’d like to pose to the blogosphere: If you were designing an EM system from the ground up, what are some specific elements from the American system that you would keep and what would you toss out like old garbage? And remember, we’re talking about a clean slate. The sky’s the limit.  

-Logan Plaster

Emergency Physicians Monthly

UK’s four-hour wait limit

Long waits have become so typical in the ED that it seems cliche to even mention them. But it’s still a serious problem. The average for a patient in the U.S. is something abysmal, but I don’t even want to ask about the maximum wait. I’m guessing you’d measure it in days, not hours. And until today, I assumed that any solution to this problem would have to be a bottom-up approach, not mandated from on high. However, I had the chance to have a few words with Dr. Edward Glucksman, the emergency physician in charge of international emergency medicine in the United Kingdom, and what he told me shed new light on the issue. 

According to Dr. Glucksman, a few years ago, Tony Blair’s government made a bold, seemingly over-reaching claim. They stated to the public that after a finite period of reforms initiated by the government, no one in the ED would wait more than 4 hours to be in a bed or sent home. Ever. This statement set off a series of extensive studies into what exactly caused wait times in the UK and how hospitals could attempt to meet this goal. According to Glucksman, the mandate actually put heat on hospitals and administrators in a way that physicians had been unable, and progress started to be made. Now, a few years out, 98% of all ED patients in the UK are in a bed or out the door in under 4 hours. That’s the max, mind you, not the mean. Now don’t get me wrong, I don’t want the federal government micromanaging the ED any more than the next guy, but this certainly got me thinking outside the box…   

-Logan Plaster

Emergency Physicians Monthly