Defining The State of Emergency Care Research

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Defining The State of Emergency Care Research

• Robert W. Neumar MD, PhD
• Chair, Research Committee
• American College of Emergency Physicians

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Future of Emergency Care Series Hospital-Based
Emergency Care At the Breaking Point
Committee on the Future of Emergency Care in the
United States Health System
2006
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Recommendations
8.2 The Secretary of the Department of Health
and Human Services (DHHS) should conduct a study
to examine the gaps and opportunities in
emergency and trauma care research, and recommend
a strategy for the optimal organization and
funding of the research effort. 8.2a This study
should include consideration of training of new
investigators, development of multi-center
research networks, funding of General Clinical
Research Centers (GCRCs) that specifically
include an emergency and trauma care component,
involvement of emergency and trauma care
researchers in the grant review and research
advisory processes, and improved research
coordination through a dedicated center or
institute. 8.2b Congress and federal agencies
involved in emergency and trauma care research
(including the Department of Transportation, the
Department of Health and Human Services, the
Department of Homeland Security, and Department
of Defense) should implement the study?s
recommendations.
Clinical Translational Science Centers (CTSCs)
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Annual NIH Funding for Departments of Emergency
Medicine
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Defining The State of Emergency Care Research

• Patients
• Presentations and Diseases
• Places
• Practioners
• Timing
• Summary

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Defining The State of Emergency Care Research

• Patients
• Presentations and Diseases
• Places
• Practioners
• Timing
• Summary

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Defining The State of Emergency Care Research

• Patients
• Presentations and Diseases
• Places
• Practioners
• Timing
• Summary

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Table 9. Emergency department visits principal
reasons for visit United States, 2005
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Table 11. ED visits by primary ED diagnosis
groups United States, 2005
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Table 11. ED visits by hospital discharge
diagnosis United States, 2005
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Projected NIH Expenditures 2009
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Defining The State of Emergency Care Research

• Patients
• Diseases
• Places
• Practioners
• Timing
• Summary

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Emergency Care
Obs. Unit
EMS Air
Home
Home
Diagnostic Radiology
OR
Cath. Lab
Emergency Department
Health care facility
Rehab
Inpatient
EMS Ground
Interv. Rad.
ICU
Public Setting
Ward/Floor
Managed care
Home
Private
Transfer
24
Defining The State of Emergency Care Research

• Patients
• Diseases
• Places
• Practioners
• Timing
• Summary

25
Emergency Care
Surgeon or Surgery Subspecialist Interventional
Radiologist Cardiologist Neurologist Critical
Care Specialist Hospitalist Ward and ICU Nurse PA
or NP
Family Nurse Primary Care Provider Rehab
Med. Specialist
EM Physician Trauma SurgeonCosultants ED
Nurse Paramedics/EMT
Family Bystander Nurse Primary Care Provider
EMT Paramedic Flight Nurse
Obs. Unit
EMS Air
Home
Home
Diagnostic Radiology
OR
Cath. Lab
Emergency Department
Health care facility
Rehab
Inpatient
EMS Ground
Interv. Rad.
ICU
Public Setting
Ward/Floor
Managed care
Home
Private
Transfer
26
Defining The State of Emergency Care Research

• Patients
• Diseases
• Places
• Practioners
• Timing
• Strengths and challenges

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Emergency Care ResearchHypothesis
Rapid diagnosis and early intervention in acute
illness or acutely decompensated chronic illness
improves patient outcomes.
Neumar, Ann Emerg Med, 2007
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Emergency Care
Surgeon or Surgery Subspecialist Interventional
Radiologist Cardiologist Neurologist Critical
Care Specialist Hospitalist Ward and ICU Nurse PA
or NP
Family Nurse Primary Care Provider Rehab
Med. Specialist
EM Physician Trauma SurgeonCosultants ED
Nurse Paramedics/EMT
Family Bystander Nurse Primary Care Provider
EMT Paramedic Flight Nurse
Obs. Unit
EMS Air
Home
Home
Diagnostic Radiology
OR
Cath. Lab
Emergency Department
Health care facility
Rehab
Inpatient
EMS Ground
Interv. Rad.
ICU
Public Setting
Ward/Floor
Managed care
Home
Private
Transfer
Minutes to Hours
Hours to Days
Days to Months
Minutes
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Emergency Care Research
Surgeon or Surgery Subspecialist Interventional
Radiologist Cardiologist Neurologist Critical
Care Specialist Hospitalist Ward and ICU Nurse PA
or NP
Family Nurse Primary Care Provider Rehab
Med. Specialist
EM Physician Trauma SurgeonCosultants ED
Nurse Paramedics/EMT
Family Bystander Nurse Primary Care Provider
EMT Paramedic Flight Nurse
Obs. Unit
EMS Air
Home
Home
Diagnostic Radiology
OR
Cath. Lab
Emergency Department
Health care facility
Rehab
Inpatient
EMS Ground
Interv. Rad.
ICU
Public Setting
Ward/Floor
Managed care
Home
Private
Transfer
Dx
Rx
O
Minutes to Hours
Hours to Days
Days to Months
Minutes
30
Emergency Care Research
Surgeon or Surgery Subspecialist Interventional
Radiologist Cardiologist Neurologist Critical
Care Specialist Hospitalist Ward and ICU Nurse PA
or NP
Family Nurse Primary Care Provider Rehab
Med. Specialist
EM Physician Trauma SurgeonCosultants ED
Nurse Paramedics/EMT
Family Bystander Nurse Primary Care Provider
EMT Paramedic Flight Nurse
Obs. Unit
EMS Air
Home
Home
Diagnostic Radiology
OR
Cath. Lab
Emergency Department
Health care facility
Rehab
Inpatient
EMS Ground
Interv. Rad.
ICU
Public Setting
Ward/Floor
Managed care
Home
Private
Transfer
Dx
Rx
O
Minutes to Hours
Hours to Days
Days to Months
Minutes
31
Emergency Care Research
Surgeon or Surgery Subspecialist Interventional
Radiologist Cardiologist Neurologist Critical
Care Specialist Hospitalist Ward and ICU Nurse PA
or NP
Family Nurse Primary Care Provider Rehab
Med. Specialist
EM Physician Trauma SurgeonCosultants ED
Nurse Paramedics/EMT
Family Bystander Nurse Primary Care Provider
EMT Paramedic Flight Nurse
Obs. Unit
EMS Air
Home
Home
Diagnostic Radiology
OR
Cath. Lab
Emergency Department
Health care facility
Rehab
Inpatient
EMS Ground
Interv. Rad.
ICU
Public Setting
Ward/Floor
Managed care
Home
Private
Transfer
Dx
Rx
O
Minutes to Hours
Hours to Days
Days to Months
Minutes
32
Emergency Care Research
Surgeon or Surgery Subspecialist Interventional
Radiologist Cardiologist Neurologist Critical
Care Specialist Hospitalist Ward and ICU Nurse PA
or NP
Family Nurse Primary Care Provider Rehab
Med. Specialist
EM Physician Trauma SurgeonCosultants ED
Nurse Paramedics/EMT
Family Bystander Nurse Primary Care Provider
EMT Paramedic Flight Nurse
Obs. Unit
EMS Air
Home
Home
Diagnostic Radiology
OR
Cath. Lab
Emergency Department
Health care facility
Rehab
Inpatient
EMS Ground
Interv. Rad.
ICU
Public Setting
Ward/Floor
Managed care
Home
Private
Transfer
Dx
Rx
O
Minutes to Hours
Hours to Days
Days to Months
Minutes
33
Emergency Care Research
Surgeon or Surgery Subspecialist Interventional
Radiologist Cardiologist Neurologist Critical
Care Specialist Hospitalist Ward and ICU Nurse PA
or NP
Family Nurse Primary Care Provider Rehab
Med. Specialist
EM Physician Trauma SurgeonCosultants ED
Nurse Paramedics/EMT
Family Bystander Nurse Primary Care Provider
EMT Paramedic Flight Nurse
Obs. Unit
EMS Air
Home
Home
Diagnostic Radiology
OR
Cath. Lab
Emergency Department
Health care facility
Rehab
Inpatient
EMS Ground
Interv. Rad.
ICU
Public Setting
Ward/Floor
Managed care
Home
Private
Transfer
Dx
Rx
O
Minutes to Hours
Hours to Days
Days to Months
Minutes
34
Emergency Care Research
Surgeon or Surgery Subspecialist Interventional
Radiologist Cardiologist Neurologist Critical
Care Specialist Hospitalist Ward and ICU Nurse PA
or NP
Family Nurse Primary Care Provider Rehab
Med. Specialist
EM Physician Trauma SurgeonCosultants ED
Nurse Paramedics/EMT
Family Bystander Nurse Primary Care Provider
EMT Paramedic Flight Nurse
Obs. Unit
EMS Air
Home
Home
Diagnostic Radiology
OR
Cath. Lab
Emergency Department
Health care facility
Rehab
Inpatient
EMS Ground
Interv. Rad.
ICU
Public Setting
Ward/Floor
Managed care
Home
Private
Transfer
Dx
Rx
O
Minutes to Hours
Hours to Days
Days to Months
Minutes
35
Defining The State of Emergency Care Research

• Patients
• Diseases
• Places
• Practioners
• Timing
• Strengths and challenges

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Emergency Care ResearchStrengths

• 24/7/365 operation
• High acuity
• High volume
• Concentrated resources
• Patient access
• Integral part of health care system

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Emergency Care ResearchChallenges

• Unscheduled
• Multiple locations and providers
• Time sensitive diagnosis and treatment
• Consent
• Standardized data elements
• Interoperable data sets
• Investigator training infrastructure

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