Transcript Document

Hospital Categorization: Role in
Advancing Emergency Medicine
Track D
September 15, 2003
Barcelona
Lewis R. Goldfrank, MD
Professor and Chairman of Emergency Medicine
New York University Medical Center
Bellevue Hospital Center
New York University School of Medicine
Medical Director, New York City Poison Center
History
1966 National Academy of
Sciences:Accidental Disease and
Disability: The Neglected Disease of
Modern Society
The leading cause of death in children
and adults and the nation’s most
important environmental health problem
History
Focus on civilian response to trauma,
simultaneously society was beginning to
appreciate the military accomplishments
for the severely injured in Korea and
Vietnam.
Progress in Seattle, Miami and Belfast
showed that death from acute myocardial
infarction could be reduced by organized
prehospital care.
History
National Highway and Safety Act 1966.
Department of Transportation funds
prehospital EMS.
1973 Public Law 93-154 the Emergency
Medical Services Systems (EMSS Act)
Development Regional EMS systems to include:
manpower, training, communications, transportation,
facilities, critical care units, public safety agencies,
consumer participation, access to care, transfer of
care, standardization of patient records, public
information and education, independent review and
evaluation, disaster linkage and mutual aid
agreements. [Fifteen key components]
State and Regional Categorization
and Implementation
Categorization has emerged as one of the
cornerstones of Federal emergency planning
and grant awarding evidence for decreased
morbidity and mortality for Newborns, Burns,
Poisonings and Trauma
Y Model
Regional Poison Information and Control Center Systems
JCAHO Level I facility minimal standards:
Comprehensive ED care 24 hrs/day with
in hospital physician coverage by
medical staff or senior level residents.
The American Heart Association and
the Committee on trauma of the
American College of Surgeons
developed guidelines for governing
location, function and design staffing
Costs of injury to society. Most of the resources currently are directed to
prevention of death while most of the economic and social cost are
associated with nonfatal injuries.
Martinez R. Putting It Together: A Model for Integrating Injury Control System
Elements. Prehospital and Disaster Medicine 1995;10:17/72.
Philosophy
ACCIDENTS aRe Not
raNdom eVents
THey are PreDIctABle
thEy CAN BE
PreVENTed
Committee on Injury Prevention and Control, Institute of Medicine. Reducing the Burden
of Injury: Advancing and Treatment. Washington, DC: National Academy Press; 1999.
The Josiah Macy Jr. Foundation Conference
on the role of emergency medicine in the
future of American medical care.
Recommendation 1
The United States Public Health Service in its next
“Statement of Public Health Objectives for the
Nation,” should specify, as a new goal, that access
to high quality emergency medical care should be
available for all persons who need such care.
Recommendation 2
The Society of Academic Emergency
Medicine (SAEM), the American College
of Emergency Physicians (ACEP), and
the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO)
should revise the classification of
emergency departments.
Recommendation 3
The deans and faculty of all LCMEaccredited medical schools, with the
assistance of the Association of
American Medical Colleges and the
Association of Academic Health
Centers, should establish in their
schools appropriately staffed and
supported academic departments of
Emergency Medicine.
By holding Level 1 emergency centers
(ECs) to objective standards based on
the quality of care delivered as well as
administrative, research, and
educational efforts, SAEM hopes to
improve patient care.
Abstract
“should revise the classification of emergency departments . . . To
reflect the level of care available in emergency departments, and
indicate whether or not facilities are adequate and whether
appropriately qualified and credentialed emergency physicians are
available 24 hours a day.”
Acad Emerg Med 1999;6:638-655
Boyd DR. A Symposium on the Illinois Trauma Program. A Systems approach to
the care of the critically injured. J Trauma 1973;13:275-320.
Categorization Standards
Staffing
Professional Training and Continuing Education
Facility
Equipment and Supplies
Ancillary Services
EC Records
Categorization Standards
Manuals and References
Continuous Quality Improvement
Education
Research
Administration
Categorization Standards
Out-of-hospital Care
Information Systems
Disaster Planning
Benchmarking
Hospital Accreditations
The New York Times
January 26, 1989