PODCAST: The changing role of emergency departments in health care systems

Business 380 reporter Kiran Sood sat down with three health care professionals on July 25 in The Gazette's offices to discuss the role of emergency departments in overall hospital care.

Participating in the discussion were Dr. Hans House, vice chair for education and interim vice chair for research at the Department of Emergency Medicine at University of Iowa Hospitals and Clinics, Mary Ann Osborn, regional senior vice president and chief care coordination officer at UnityPoint Health-St. Luke's Hospital, and Dr. Matthew Aucutt, medical director of the Emergency Department at Mercy Medical Center.

• Listen to part one of the conversation here
• Listen to part two of the conversation here

The following is an excerpt from that conversation.

Kiran Sood: The use of emergency departments is growing faster than the use of other parts of the American medical system. Why do you think that is?

Dr. Matthew Aucutt: I think that we actually do have an access problem. We have an aging primary care physician population and people aren't able to get in in a timely fashion and consumers are more educated now and they do an assessment, they may get online to see what they think they have and what tests they may need.

A lot of people are making their own decisions about their health care and bypassing maybe urgent care.

Sood: Do you all agree that office-based physicians are directing to emergency departments patients they previously would have admitted to the hospitals themselves?

Dr. Hans House: Let me tell you a story of a friend of mine that I took care of in the ER a few weeks ago. She was having fatigue, she was extremely tired.

She works at a farm. She normally has a lot of energy and she just couldn't get her chores done.

She noticed some numbness in her arms and some tightness. We were concerned that maybe she was having some cardiac problems. We directed her to the emergency department. She remained in our observation unit in the ED and she got her test.

I asked her later, 'If you had gone to your primary care physician for this same work, would you have been able to get in?' And she said, without a question, her first visit, just calling for an appointment, would have taken at least three weeks.

Sood: It seems to me that you're saying there is a benefit to visiting the emergency department that patients may not get elsewhere.

House: It's efficient.

Mary Ann Osborn: I think that's one of the draws - everyone knows that you can access diagnostic tests, you can access consultants, all of it that you need to determine what's going on with you, you can get through the ED in a one-stop shop.

From my perspective, I think that's part of the issue that we have to get really good at sorting out.

We need open access in some of our primary care physicians' offices. We need open access in some of our diagnostics, which is a different concept.

We're all used to scheduling every moment and every open slot that we have, both in the office and in the diagnostic centers, and yet we know every day people get urgently ill. It's not like people can wait three weeks to be treated, so how do we accommodate people without everyone having to go through the emergency room?

And yet we want the emergency room there and available and ready for the people that really need it.