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Critical Pathways for Post–Emergency Outpatient Diagnosis and Treatment: Tools to Improve the Value of Emergency Care
Author(s) -
Schuur Jeremiah D.,
Baugh Christopher W.,
Hess Erik P.,
Hilton Joshua A.,
Pines Jesse M.,
Asplin Brent R.
Publication year - 2011
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2011.01096.x
Subject(s) - medicine , emergency department , medical diagnosis , ambulatory care , medical emergency , emergency medicine , intensive care medicine , critical pathways , emergency medical services , health care , nursing , business , process management , pathology , economics , economic growth
ACADEMIC EMERGENCY MEDICINE 2011; 18:e52–e63 © 2011 by the Society for Academic Emergency Medicine Abstract The decision to admit a patient to the hospital after an emergency department (ED) visit is expensive, frequently not evidence‐based, and variable. Outpatient critical pathways are a promising approach to reduce hospital admission after emergency care. Critical pathways exist to risk stratify patients for potentially serious diagnoses (e.g., acute myocardial infarction [AMI]) or evaluate response to therapy (e.g., community‐acquired pneumonia) within a short time period (i.e., less than 36 hours), to determine if further hospital‐based acute care is needed. Yet, such pathways are variably used while many patients are admitted for conditions for which they could be treated as outpatients. In this article, the authors propose a model of post‐ED critical pathways, describe their role in emergency care, list common diagnoses that are amenable to critical pathways in the outpatient setting, and propose a research agenda to address barriers and solutions to increase the use of outpatient critical pathways. If emergency providers are to routinely conduct rapid evaluations in outpatient or observation settings, they must have several conditions at their disposal: 1) evidence‐based tools to accurately risk stratify patients for protocolized care, 2) systems of care that reliably facilitate workup in the outpatient setting, and 3) a medical environment conducive to noninpatient pathways, with aligned risks and incentives among patients, providers, and payers. Increased use of critical pathways after emergency care is a potential way to improve the value of emergency care.