The Future of Emergency Care Reports, One Year Later: Assessing the Impact of the IOM

Abstract

The Institute of Medicine (IOM) released a landmark series of reports one year ago on the emergency care system in the United States, stating it was “at the breaking point.” The 3 reports, which made 60 recommendations to fix the system, garnered widespread attention from the media and health care professionals, yet a full year later it is unclear whether this initial splash just triggered a few ripples, or may eventually generate waves of change. One fact is clear—few of the IOM recommendations contained within “The Future of Emergency Care in the United States Health System” reports have yet been acted upon. That is to be expected, said Dr. Gail Warden, president emeritus of the Henry Ford Health System in Detroit and the chair of the report committee. “Overall, I’m encouraged,” Warden said. “It’s pretty clear there’s a lot of dialogue going on, and that’s what you would expect in the first year. This is probably a 5-year plan to get accomplished what we need to do. The progress we’re seeing, the hearings before Congress last summer, these are the critical first steps that have to be taken.” But other emergency care officials speak with more urgency when asked if progress has been made since the reports’ release. “Like a lot of our members, I’m impatient,” said Dean Wilkerson, executive director of the American College of Emergency Physicians (ACEP). “I’d like to see more progress.” The IOM reports paint a bleak picture of emergency care. The essential problem is one of supply and demand. In the decade prior to 2003, ED use rose 26%, while the total number of emergency departments (EDs) decreased by 425. As a result, the report noted, an ambulance carrying a sick patient is turned In short, waiting time is increasing, boarding is worsening and no one believes the EDs in any US metro areas are prepared for the crush of a significant terrorist attack, natural disaster or pandemic, such as avian influenza. The report called for myriad steps to address these problems: everything from an instant infusion of funds for emergency care from Congress to an end of the practice of boarding patients in EDs. These dire warnings captured attention.