Counselman F L, Schafermeyer R W, Garcia R, Perina D G
Department of Emergency Medicine, Eastern Virginia Medical School and Emergency Physicians of Tidewater, Norfolk, VA 23507, USA.
Ann Emerg Med. 2000 Nov;36(5):446-50. doi: 10.1067/mem.2000.111097.
To survey academic departments of emergency medicine concerning their operation and clinical practice.
A survey was mailed to the chairs of all 56 academic departments of emergency medicine in the United States requesting information concerning operations and clinical activity in budget year 1997-1998 compared with 1995-1996. These results were then compared with a similar survey conducted in the fall of 1996, examining the 1995-1996 academic year compared with the 1994-1995 academic year.
Forty-one (73%) academic departments of emergency medicine responded. For 1997-1998, compared with 1995-1996, 24 (59%) academic departments of emergency medicine reported an increase in emergency department patient volume; 10 (24%) reported a decrease. Twenty-four (51%) academic departments of emergency medicine reported an increase in ED patient severity, whereas 7 (15%) reported a decrease. Twenty-five (61%) academic departments of emergency medicine reported an increase in net clinical revenue for emergency medicine services, and 9 (22%) reported a decrease. Only 9 (22%) academic departments of emergency medicine reported other academic departments within their university/medical center aggressively directing patients away from the ED compared with 14 (30%) in the previous study. The percentage of academic departments of emergency medicine using midlevel providers remained essentially the same over time (68% versus 66%). In both studies, midlevel providers were used most commonly in a fast-track setting. Only 37% of academic departments of emergency medicine reported having an observation unit; staffing in all cases was by emergency physicians. Since the last survey, 38 (93%) academic departments of emergency medicine reported their medical center or hospital negotiating with managed care organizations to provide services. Unfortunately, only 41% of chairs were involved in these discussions. Between January 1, 1997, and the 1998 fall survey, 29% of academic departments of emergency medicine reported their university merging with another university system, and 19% reported such mergers being discussed. Similarly, between January 1, 1997, and fall 1998, 22% of academic departments of emergency medicine reported their institution merging with a private entity, whereas 16% reported ongoing discussions.
Academic departments of emergency medicine have experienced some encouraging trends: an increase in ED patient volume, patient severity, and net clinical revenue during the study period. Midlevel providers continue to be used primarily in fast-track areas of EDs. An area of potential growth for academic departments of emergency medicine is observation medicine, because only one third of academic departments of emergency medicine have such a unit. Academic medical centers have experienced a significant increase in merger activity during the study period.
调查急诊医学学术部门的运营及临床实践情况。
向美国56个急诊医学学术部门的主任邮寄了一份调查问卷，询问1997 - 1998预算年度与1995 - 1996年相比的运营及临床活动信息。然后将这些结果与1996年秋季进行的一项类似调查进行比较，该调查考察的是1995 - 1996学年与1994 - 1995学年的情况。
41个（73%）急诊医学学术部门做出了回应。与1995 - 1996年相比，1997 - 1998年，24个（59%）急诊医学学术部门报告急诊科患者数量增加；10个（24%）报告减少。24个（51%）急诊医学学术部门报告急诊科患者病情严重程度增加，而7个（15%）报告减少。25个（61%）急诊医学学术部门报告急诊医学服务的净临床收入增加，9个（22%）报告减少。与上一项研究中14个（30%）相比，只有9个（22%）急诊医学学术部门报告其所在大学/医学中心的其他学术部门积极引导患者不前往急诊科。随着时间推移，使用中级医疗服务提供者的急诊医学学术部门比例基本保持不变（68%对66%）。在两项研究中，中级医疗服务提供者最常用于快速通道区域。只有37%的急诊医学学术部门报告设有观察单元；所有情况下均由急诊医师配备人员。自上次调查以来，38个（93%）急诊医学学术部门报告其医学中心或医院正在与管理式医疗组织谈判以提供服务。遗憾的是，只有41%的主任参与了这些讨论。在1997年1月1日至1998年秋季调查期间，29%的急诊医学学术部门报告其大学与另一大学系统合并，19%报告正在讨论此类合并。同样，在1997年1月1日至1998年秋季期间，22%的急诊医学学术部门报告其机构与一个私人实体合并，而16%报告正在进行相关讨论。
急诊医学学术部门呈现出一些令人鼓舞的趋势：在研究期间，急诊科患者数量、患者病情严重程度及净临床收入均有所增加。中级医疗服务提供者仍主要用于急诊科的快速通道区域。急诊医学学术部门的一个潜在增长领域是观察医学，因为只有三分之一的急诊医学学术部门设有这样的单元。在研究期间，学术医学中心的合并活动显著增加。
