The Future of Emergency Medicine

Counter-culture, hippies, the civil rights movement, and a quieter transformation – the rise of emergency medicine as a specialty – that was the sixties. The decade gave rise to the need to care for a rapidly growing (and aging) population of patients that was seeking immediate and unscheduled medical care for emergency conditions. The mass adoption of cars with the inevitable accidents that followed was part of this context. Twenty years later, emergency medicine was well established as a specialty. That’s how it started, but what does the future of emergency medicine look like today?

How is Emergency Medicine Evolving?

Over the last decade or so, US Emergency Departments have evolved to become the front door for access to the entire health care system, requiring skills and capacity to respond to a range of needs beyond emergency care. Importantly, they’re also a primary source of hospital admissions.

By 2017, nearly half of all US medical care was delivered by Emergency Departments, and because the ED triggers most hospital admissions, it’s a crucial contributor to hospital finances. As a place of access to consistent care for those without health insurance and those seeking quick attention to their problems, people rely on EDs for primary health care, mental health services, social services and a variety of other vital services that are not necessarily emergency related.

The COVID-19 pandemic has resulted in fewer emergency admissions of the ‘traditional’ kind – myocardial infarctions, cerebrovascular accident and injuries. Social restrictions, along with the public’s fear of contracting the virus in hospitals and reluctance to overload the healthcare system, have had a major impact on EDs all over the world. Usual functioning has been disrupted; new clinical and ethical challenges for physicians have emerged. But emergency medicine is far from a dying field – physicians will always be needed to provide specialized, curated care for unplanned and unexpected emergency events. And there is no healthcare scenario plan that foresees a sustained reduction in these.

What are the Challenges in Emergency Medicine Today?

Challenges in emergency medicine come in legal, ethical, technological, capacity-related, and clinical forms. Some of them affect healthcare in general, but emergency medicine in particular. Litigation and the specter of medical liability, for example, especially in North America, drive particular pressures in emergency health care. 

The Emergency Medicine Resident Association’s (EMRA) 2019 Advocacy Handbook found that 7% of emergency physicians are sued each year. A contributing factor is overcrowding, which US emergency rooms have struggled with for years. Crowding in EDs threatens the quality, safety, and timeliness of emergency care, whether caused by environmental factors or operational inefficiencies. Yet, speed – from ambulance to stretcher through triage, stabilization and admission or discharge – is the foundation of successful patient care. Hospitals are increasingly challenged to find ways to improve patient-care workflows, reduce overcrowding, and achieve maximum care with minimum wait.

Emergency treatment that involves the regular transfer of patients into crowded, noisy, and often chaotic ED environments make emergency medicine vulnerable to medical error. As the New York Times pointed out, “With patients crammed in every available space, ER nurses and other health care providers quickly become overwhelmed, leading to fatal medical errors and significant delays that affect the outcome of patients who have suffered heart attacks, strokes or infections.” Some of these errors and delays are down to miscommunication. According to some analyses, up to 80% of clinical errors (across the healthcare system), are due to miscommunication between medical staff. Can technology minimize error and improve patient workflows?

Image source: nytimes.com

What is the Role of Technology in Responding to Challenges in Emergency Medicine?

The potential of technology for emergency medicine is expanding rapidly – apps for streamlining care, virtual care through telemedicine, point-of-care real-time diagnostic and screening devices, wearables with sensors for paramedics, drones that deliver care by air, and the advanced use of the humble bar code to streamline patient flows – these are just a few.  

Many of these technologies are expected to help with ED challenges around escalating healthcare costs, mismatched resource utilization, avoidable admissions, medical error, swift diagnostics, and overcrowding. So it’s unsurprising that Healthcare Global reports that healthcare providers worldwide are rapidly adopting emerging medical technology: “More companies are turning to technology to increase the speed in assessing patients, providing more time to care for patients suffering terminal and chronic illnesses. … We are witnessing a sharp rise in medical technology – an industry estimated to be worth $467bn in 2020. The rise in AR and virtual reality apps have only served the change in the market, with many realizing the revolutionary potential of technology. As our healthcare professionals become overburdened with complicated procedures and more patients, technology is beginning to save and improve lives.”

The US spend on healthcare is around 18% of GDP, almost double that of other developed countries. Fortune Business Insights expects that healthcare, including emergency medicine, will achieve massive cost savings through the increased implementation of emerging medical technology. The Internet of Things (IoT) is expected to save around 100 billion dollars a year on US healthcare spending, with 64% of physicians believing that the IoT reduces the burden on nurses and doctors.

Together, telemedicine, apps, drones and artificial intelligence (AI) are saving life and limb, and allowing more points of access to the healthcare system than brick and mortar ED departments do alone. AI, in particular, is expected to gain traction alongside the current expansion in use cases and realization of investment potential. 

What is the Future of Emergency Medicine and AI?

The field of medical AI is buzzing as adoption of these technologies continues to gain traction with proven use cases in emergency medicine. These include clinical decision support, triage, admin support, predictive analytics and diagnostic imaging.

The COVID-19 pandemic increased focus on AI investment as, besides the potential to improve clinical support, it provides automated solutions to repetitive, time-consuming tasks. This is particularly important in ED contexts where speed is crucial and machine learning (ML) takes swift charge of routine data entry and processing tasks. Before the pandemic, interest in AI was already accelerating. A 2019 survey found that one in two C-suite executives deployed AI and ML in their healthcare organizations. In upper-market organizations, AI and ML use was at 58%. As the Canadian virtual community of emergency medicine practitioners, CanadiEM, concludes: “AI has received considerable media attention for its applications in medicine given its ability to outperform human expertise in clinical predictions, diagnosis, and monitoring. The emergency department (ED) may be uniquely situated to benefit from AI, due to the diversity of patient information, the necessity of balancing probabilities for risk stratification, and the rapid decision-making.”

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