A survey of academic departments of emergency medicine regarding operation and clinical practice: two years later.

Abstract

To survey academic departments of emergency medicine (ADEMs) concerning their operation and clinical practice. A survey was mailed to the chairs of the 53 ADEMs in the United States established prior to 1999 (as listed on the Society for Academic Emergency Medicine website) requesting information on operations and clinical activity in budget year 1999-2000 compared with 1997-1998. These results were then compared with results of similar surveys conducted in the autumns of 1996 and 1998. Forty-eight ADEMs (91%) responded. For 1999-2000, compared with 1997-1998, 38 ADEMs (79%) reported an increase in emergency department (ED) patient volume; five (10%) reported a decrease. Thirty-one (65%) ADEMs reported an increase in ED patient severity of illness, whereas only one (2%) reported a decrease. Thirty-two ADEMs (67%) reported an increase in net clinical revenue, and eight (17%) reported a decrease. Only five ADEMs (10%) said that other academic departments within their university/medical center aggressively directed patients away from the ED, compared with nine (22%) in the 1998 study. The percentage of ADEMs using mid-level providers remained essentially unchanged over the three studies-31 (66%) in 1996 versus 28 (68%) in 1998 and 31 (65%) in the present study. For all the studies, mid-level providers were most commonly used in a fast-track setting. The number of ADEMs with an observation unit has also remained relatively stable-18 (38%) in the current study versus 15 (31%) in the 1998 study. In the current study, only two (4%) ADEMs experienced a merger with another university system, compared with 12 (29%) in 1998. Eight (17%) ADEMs reported that their institution had merged with a private entity in the current study, compared with nine (22%) in 1998. ADEMs continue to experience some very positive trends, namely, increases in ED patient volume, in severity of patient illness, and in net clinical revenue.