Study Objectives: Within the current climate of ED crowding, hospitals are continually experimenting with new ways to streamline patient throughput. One option to prevent crowding is early discharge of patients whose specialist evaluation could safely be provided in the outpatient setting. However, reluctance on the part of the patient, the specialist, and emergency physician to discharge patients without confirmed follow-up leads to increased observation and admission of certain patient groups. At our institution, we noted that a significant number of patients were waiting on both the inpatient floor and the ED observation unit for specialty consultations, which could have been done in the outpatient setting were follow-up guaranteed. Our objective was to determine if initiating a novel 'gold card' program, where patients were guaranteed follow-up with a group of participating specialists within two business days would be feasible in the community hospital setting.Methods: From August 2016 to March 2017, we conducted a prospective observational study of all discharged ED patients who participated in the 'gold card' program. This study was performed through a community hospital ED with 98,324 annual visits. All adult (age > 18) patients who were deemed by the treating emergency physician as candidates for a 'gold card' were screened by a care coordinator to confirm insurance eligibility and provided a 'gold card.' This 'gold card' guaranteed an appointment with the selected specialist within two business days. All patients who participated in the program were contacted to evaluate the feasibility of the process. Our primary outcome measure was the number of 'gold card' recipients who completed an appointment within two business days of discharge. Our secondary outcomes included: 1) patient satisfaction with the process, 2) reasons for not completing a gold card appointment, and 3) an analysis of utilized specialists. The data was analyzed using descriptive statistics.Results: From August 2016 through March 2017, there were 65,912 visits to our ED. 42,886 (65%) of these patients were discharged home, 17,202 (26%) were admitted, and 5,824 (9%) were sent to ED observation. Of the total ED discharges during this period, 1,508 patients (3.5%) received a gold card. Within that cohort, 119 patients (7.8%) chose not to go to the appointment: 86 (72%) canceled and 33 (28%) no showed. Of the 1,389 remaining gold card patients, 1,264 (91%) were seen within two business days, 109 (8%) were seen within more than two business days, 15 (1.07%) were unable to schedule an appointment, and 1 patient (<1%) was readmitted. A follow-up phone survey was completed on 1,009 patients (74%), demonstrating an average monthly patient satisfaction rate of 98.7% with the program, alongside increasing 'gold card' usage (See Figure 1). There was a broad range of specialty participation with gastroenterology (22.7%), cardiology (13.4%), and neurology (13.0%) encompassing almost half of all referrals.Conclusions: The 'gold card' program represent...

The conceptual definition of systems-based practice (SBP) does not easily translate into directly observable actions or behaviors that can be easily assessed. At the Academic Emergency Medicine consensus conference on education research in emergency medicine (EM), a breakout group presented a review of the literature on existing assessment tools for SBP, discussed the recommendations for research tool development during breakout sessions, and developed a research agenda based on this discussion.ACADEMIC EMERGENCY MEDICINE 19:1366-1371 © 2012 by the Society for Academic Emergency Medicine T he inclusion of systems-based practice (SBP) as one of the Accreditation Council for Graduate Medical Education (ACGME) core competencies highlights the importance of the health care system on the ability of a physician to provide competent and effective patient care.1 Physicians must be able to collaborate with other members of the health care team, consider costs when weighing risks and benefits, improve system performance by identifying system errors and implementing potential solutions, and continue to advocate for quality patient care. This set of skills is also described in the CanMEDS Physician Competency Framework as elements of the physician role as a collaborator, manager, and health advocate. Despite a recent shift in the ACGME assessment system to the Next Accreditation System, the framework for assessing milestones within the competencies still requires specific tools to assess SBP.3 Although the conceptual definition of SBP does not easily translate into observable actions or behaviors, the Council of Emergency Medicine Residency Directors (CORD) was able to develop emergency medicine (EM)-specific evaluation domains for SBP. 4 These included specific actions and behaviors that are directly observable and facilitated real-time and summative feedback. However, this set of observable behaviors did overlook some pertinent areas, such as situational awareness and participation in systems improvement. Similarly, by using the Can-MEDS roles of collaborator, manager, and health advocate, Graham et al. also developed a comprehensive list of observable actions that readily translated into assessments. 5This article summarizes the authors' review of the current assessment tools for the SBP competency used in EM and non-EM residencies, both within and outside the United States. As a result of several small group discussions during the breakout session on the assessment of observable learner performance at the 2012 Academic Emergency Medicine (AEM) consensus conference on education research in EM, we developed a research plan for assessment tool development. PROCESS AND CONSENSUSWe reviewed the literature on SBP assessment, searching the Medline and Pubmed databases by combining the terms "systems based" with "evaluat* OR assess*" and "competenc*" as well as combining "simulation" or "portfolio" with "systems based practice," yielding 156 and 309 references, respectively.

No abstract

No abstract