Emergency medicine has played a critical role in the delivery of health care for decades, serving as the foundation for treating acute illness and severe injury, addressing key public health challenges and ensuring effective medical response to disasters and mass casualty events. Today’s emergency departments are providing even more vital services in their expanding role as the health-care entry point for millions of people each year. Emergency physicians make vital decisions every day about high-quality care for their patients and cost-effective treatments. They also coordinate care among providers and set the direction of care for hospitalized patients and for discharged patients in appropriate follow-up settings.

In an environment in which the nation seeks to enhance access to care, improve quality of care, and generate meaningful cost containment, emergency departments are uniquely positioned to significantly advance these goals. To that end, the American College of Emergency Physicians makes the following recommendations.

Protect access to emergency care as health care reforms are implemented. As more Americans become insured under the Affordable Care Act, many for the first time, emergency departments are likely to play a more pivotal role and to become more stressed. Measures to protect access to high-quality emergency care, such as ensuring an adequate health professional workforce and increasing hospital capacity, are essential.

Support programs that recognize the pivotal role emergency medicine plays in care coordination and transitions of care. Emergency physicians provide services that were once reserved for inpatient hospital units and other health care facilities. They mobilize medical resources to diagnose and treat patients, refer patients to other specialists, and coordinate patients’ transitions to other settings for additional care. Initiatives that support and expand these efforts can help substantially enhance quality of care and reduce costs.

Reduce the incidence of hospital crowding and boarding of admitted patients in the emergency department. Timely access to quality emergency care continues to be threatened by crowding, boarding, and ambulance diversion. Further development is needed of effective low- and no-cost strategies to ensure implementation of systems to identify and prevent these problems.

Enact federal and state medical liability reforms that enhance timely access to quality care, particularly reforms that provide appropriate liability protections for EMTALA-mandated care. Failure to enact meaningful liability reform continues to create barriers to health care access, including access to essential on-call specialists in emergencies. Additionally, meaningful reforms can help reduce unnecessary health care costs associated with the widespread practice of defensive medicine.

Increase coordination and regionalization of specialized emergency services and support funding of federally authorized regional pilot programs. Regionalization helps direct patients with acute or life-threatening illness or injury to designated facilities that can provide comprehensive, specialized treatment, allowing for more effective use of limited health care resources.

Devote consistent federal and state funding to ensure adequate and sustainable local and regional disaster preparedness. Federal and state funding for emergency medical preparedness and response to natural and man-made disasters remains inadequate. Sustained investment in disaster preparedness is critical for communities and states to be able to respond in times of crisis.

Continue to increase the use of systems, standards, and information technologies to track and enhance the quality and patient safety environment. Health care systems need to provide the highest quality of care possible. To that end, all stakeholders must maintain an unwavering commitment to the continued development and implementation of initiatives that effectively measure and improve quality of care through process improvements, data collection and monitoring, and technological enhancements.

Continue pursuit of state laws that help reduce the number of preventable deaths and injuries, particularly those that address traffic-related injuries and fatalities. Many emergency visits are driven by preventable injuries or exacerbations of illnesses, such as diabetes and cardiovascular disease, which can be prevented or effectively managed. Supporting programs aimed at addressing these problems through public education and changes in state and local policy is essential.

Expand access to standardized and user-friendly state and/or federal prescription drug monitoring programs to decrease unintentional deaths by drug overdose. The epidemic of prescription drug overdose plagues communities nationwide and requires a multi-faceted response by many stakeholders. One element of this response must be to expand robust government prescription drug monitoring programs that enable providers to quickly assess the recent prescription drug history of patients.

Fund graduate medical education programs that support emergency care, especially those related to addressing physician shortages in disadvantaged areas and in rural areas. Emergency medicine residency programs must have an adequate, predictable, and stable source of funds to ensure an ample supply of residency trained emergency medicine specialists. Groups tasked with examining or revising policy relating to GME reform should include emergency medicine representatives.

Support emergency medicine research, including basic, clinical, and translational research into improving the delivery of emergency care services. The continued advancement of quality emergency medicine is dependent upon high quality research. Support is needed for all types of emergency medicine research, with a focus on developing and disseminating evidence-based best practices to emergency physicians and programs.

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