From Fragmentation to Integration in Emergency Medicine: Providing Care Our Patients Deserve

Abstract

The emergency care systems of most communities around the world have multiple components through which patients move and which are, at best, disjointed and not well coordinated. Illnesses and injuries which begin in the community and frequently preventable often do not have the benefit of bystander assistance or dedicated immediate emergency ambulance care and arrive at Emergency Departments that are crowded. Patients often spend long hours in these Emergency Departments and, if requiring inpatient care, have to wait many hours before an inpatient bed becomes available. Those requiring further convalescent care may often find inadequate arrangements available for them to recover smoothly. The end result is delays and adverse clinical outcomes that are often not measured or even appreciated. This report discusses each of ten components of the emergency care system as in exists in most communities, including injury and illness prevention, the community burden of emergencies, bystander first responder care, ambulance-based second responder care, emergency department crowding and its contributory factors, transitions of care to the inpatient departments and community convalescent care units, coordination of emergency departments in the community, the patient’s family and, of course, the emergency patient. The effects of fragmentation in each of these components are described and strategies to address each mentioned. There is a need for a patient-centric, integrated approach to the provision of emergency care in any community which can break down the barriers created by fragmented care and provide the seamless, high-quality care that all our patients deserve.