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AHRQ Takes Steps to Implement IoM Recommendations on Emergency Care


Carolyn M. Clancy, M.D.
Director
Agency for Healthcare Research and Quality

Three reports released in June by the Institute of Medicine (IOM) urged a major overhaul of the U.S. emergency-care system. Creating a coordinated, accountable system that uses information technologies and evidence-based indicators to improve efficiency, safety, and patient flow was one of IoM’s key recommendations.

Unless major reforms are undertaken at the local, state and federal levels, the IoM warned, hospital emergency departments (EDs) will be increasingly unable to provide patients with the quality of emergency care they expect. In addition, the nation’s emergency medical care system will remain ill-prepared to handle a major disaster, such as a terrorism event, infectious disease outbreak, or other public health emergency.

Changing Population, Changing Needs
Between 1993 and 2003, the nation’s population grew by 12% and hospital admissions increased by 13%. ED visits, however, increased at a rate of 26%, double the rate of increase in admissions.

Recommendations for Change
To address the escalating crisis in emergency care, the IOM report offered a wide range of recommendations.

AHRQ Activity
The Agency for Healthcare Research and Quality (AHRQ) has already made significant investments that address many of the IoM’s recommendations, including using IT to improve quality of ED care and addressing emergency preparedness.

For example, as part of a three-year grant, the Louisiana Rural Health Information Technology Partnership will implement and evaluate the impact of a computerized medical record in the ED of 17 facilities in their critical access hospital network. The technology is expected to improve information exchange and continuity of care by documenting all elements of an ED visit. We have also extended important work on computerized electrocardiographs and diagnosis support for EMS teams, helping them triage patients with acute chest pain.

AHRQ has also developed an extensive portfolio of disaster response tools and resources, many with immediate relevance for emergency care. A central focus of has been assessing and enhancing the surge capacity of the health care system. Surge capacity is the system’s ability to expand quickly beyond normal services to meet a sharp increase in demand for medical care. As a primary access point in the health care system, the nation’s EDs are critical components in ensuring appropriate surge capacity.

In December 2005, AHRQ issued a report that explored the feasibility of a national real-time hospital-bed tracking system to address a surge of patients during a mass casualty event, the National Hospital Available Beds for Emergencies and Disasters (HAvBED) System. The report collected and integrated data from existing reporting systems and from hospitals outside those systems that entered data via secure Web sites.

Implementation of the IOM recommendations will offer millions of Americans assurance that their emergency care system is capable of providing fast, safe, and efficient care when they need it most. AHRQ is committed to enhancing emergency services and assuring their quality and safety.