Graduate Medical Education, Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
Acad Med. 2010 Mar;85(3):490-5. doi: 10.1097/ACM.0b013e3181ccb628.
Emergency medicine (EM) has grown rapidly over the past 50 years, evolving from a specialty defined by its locational identity--a hospital receiving room--to the specialty picked fourth-most-frequently by graduating U.S. medical students and to being the focal point of clinical care and of research on time-sensitive medical conditions. The authors review the forces that led to the growth of EM and those that will shape its future--in particular, cost, quality, and technology. A balancing of cost and quality considerations will likely drive EM education and research endeavors. The future of the field will be determined in part by resolution of the tension between the current inefficient conditions of emergency departments (EDs), which are crowded because of the temporary boarding of admitted patients for whom a bed is not yet ready, and the desired provision of quality care under emergent conditions. That is, patients with stroke, myocardial infarction, sepsis, or severe injuries from trauma require a working diagnosis and interventions that are initiated shortly after presentation, but ED personnel distracted by the demands of caring for boarded patients are unable to deliver optimal ED care. The reduction or elimination of boarding will enhance education and research within EDs and will contribute to an efficient system of high-quality EM services.
急诊医学（EM）在过去的 50 年里迅速发展，从一个以地理位置为特征的专业——接收医院的病房——演变为美国医学生选择的第四大专业，成为临床护理和时间敏感型医疗条件研究的焦点。作者回顾了导致急诊医学发展的力量以及将塑造其未来的力量——特别是成本、质量和技术。成本和质量考虑因素的平衡可能会推动急诊医学教育和研究工作。该领域的未来将部分取决于解决急诊科（ED）目前效率低下的问题，拥挤的 ED 是由于需要临时安置等待床位的住院患者，以及在紧急情况下提供高质量护理的愿望。也就是说，中风、心肌梗死、败血症或创伤引起的严重损伤的患者需要在出现后不久就进行诊断和干预，但由于需要照顾住院患者，ED 人员分心，无法提供最佳的 ED 护理。减少或消除住院将增强 ED 内的教育和研究，并有助于建立高效的高质量急诊医学服务系统。
