The Patient-Friendly ER: From Hello to Goodbye

Last week's column focused on some of the many challenges we've encountered trying to create a more patient-centered transitions program for moving patients from the inpatient setting to the outpatient setting. As we have been going through this process, and through our everyday lives, we realized that another venue with a delicate transition is moving into and out of the emergency room.There are many conditions that we would rather not see in our office and are much more appropriate for triage and care in the emergency department. Acute myocardial infarction, stroke, sepsis. Impending delivery of a baby. But many of those we have, in fact, actually seen in our outpatient practice (and luckily quite quickly triaged over to the emergency room).

Obviously, time in the emergency room can be fraught with anxiety for our patients, with risks of missed opportunities, and, in some cases, a recipe for disaster.In many cases, we do not want our patients to have to go to the emergency room. Under a patient-centered medical home model, the ability to access your primary care provider for telephone advice, electronic communication, and even urgent, same-day appointments could eliminate the need for many emergency room visits. Once an emergency room visit has been deemed necessary, it is imperative that we fully participate in this process along with our patients, to make sure that they receive adequate and safe care, and that, at the end, a safe discharge plan is created.

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