Handel Daniel A, Sklar David P, Hollander Judd E, Asplin Brent R, Hedges Jerris R
Center for Policy Research in Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
Acad Emerg Med. 2007 Mar;14(3):261-7. doi: 10.1197/j.aem.2007.01.011.
The findings in the Institute of Medicine's Future of Emergency Care reports, released in June 2006, emphasize that emergency physicians work in a fragmented system of emergency care with limited interhospital and out-of-hospital care coordination, too few on-call specialists, minimal disaster readiness, strained inpatient resources, and inadequate pediatric emergency services. Areas warranting special attention at academic medical centers (AMCs), both those included within the report and others warranting further attention, were reviewed by a distinguished panel and include the following: 1) opportunities to strengthen and leverage the educational environment within the AMC emergency department; 2) research opportunities created by emergency medicine (EM) serving as an interdisciplinary bridge in the area of clinical and translational research; 3) enhancement of federal guidelines for observational and interventional emergency care research; 4) recognition of the importance of EM residency training, the role of academic departments of EM, and EM subspecialty development in critical care medicine and out-of-hospital and disaster medicine; 5) further assessment of the impact of a regional emergency care model on patient outcomes and exploration of the role of AMCs in the development of such a model (e.g., geriatric and pediatric centers of EM excellence); 6) the opportunity to use educational loan forgiveness to encourage rural EM practice and the development of innovative EM educational programs linked to rural hospitals; and 7) the need to address AMC emergency department crowding and its adverse effect on quality of care and patient safety. Strategic plans should be developed on a local level in conjunction with support from national EM organizations, allied health care, specialty organizations, and consumer groups to help implement the recommendations of the Institute of Medicine report. The report recommendations and other related recommendations brought forward during the panel discussions should be addressed through innovative programs and policy development at the regional and federal levels.
2006年6月发布的医学研究所《急诊护理的未来》报告中的研究结果强调,急诊医生工作的急诊护理系统分散,医院间和院外护理协调有限,随叫随到的专科医生过少,灾难准备不足,住院资源紧张,儿科急诊服务不足。一个杰出的专家小组审查了学术医疗中心(AMC)需要特别关注的领域,包括报告中提及的领域以及其他需要进一步关注的领域,具体如下:1)加强和利用AMC急诊科教育环境的机会;2)急诊医学(EM)在临床和转化研究领域作为跨学科桥梁所创造的研究机会;3)加强联邦关于观察性和干预性急诊护理研究的指导方针;4)认识到EM住院医师培训、EM学术部门的作用以及EM亚专科在重症医学、院外和灾难医学中的发展的重要性;5)进一步评估区域急诊护理模式对患者结局的影响,并探索AMC在此类模式发展中的作用(例如,老年和儿科EM卓越中心);6)利用教育贷款减免来鼓励农村EM实践以及发展与农村医院相关的创新EM教育项目的机会;7)解决AMC急诊科拥挤问题及其对护理质量和患者安全的不利影响的必要性。应在国家EM组织、联合医疗保健、专业组织和消费者团体的支持下,在地方层面制定战略计划,以帮助实施医学研究所报告的建议。报告建议以及小组讨论期间提出的其他相关建议应通过区域和联邦层面的创新项目和政策制定来解决。