The efficacy and value of emergency medicine: a supportive literature review

Abstract

Study objectivesThe goal of this study was to identify publications in the medical literature that support the efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. In this study we use the term "value" to refer both to the "efficacy of clinical care" in terms of achieving desired patient outcomes, as well as "efficiency" in terms of effective and/or cost-effective utilization of healthcare resources in delivering emergency care. A comprehensive listing of publications describing the efficacy or value of EM has not been previously published. It is anticipated that the accumulated reference list generated by this study will serve to help promote awareness of the value of EM as a medical specialty, and acceptance and development of the specialty of EM in countries where EM is new or not yet fully established.MethodsThe January 1995 to October 2010 issues of selected journals, including the EM journals with the highest article impact factors, were reviewed to identify articles of studies or commentaries that evaluated efficacy, effectiveness, and/or value related to EM as a specialty or to clinical care delivered by EM practitioners. Articles were included if they found a positive or beneficial effect of EM or of EM physician-provided medical care. Additional articles that had been published prior to 1995 or in other non-EM journals already known to the authors were also included.ResultsA total of 282 articles were identified, and each was categorized into one of the following topics: efficacy of EM for critical care and procedures (31 articles), efficacy of EM for efficiency or cost of care (30 articles), efficacy of EM for public health or preventive medicine (34 articles), efficacy of EM for radiology (11 articles), efficacy of EM for trauma or airway management (27 articles), efficacy of EM for using ultrasound (56 articles), efficacy of EM faculty (34 articles), efficacy of EM residencies (24 articles), and overviews and editorials of EM efficacy and value (35 articles).ConclusionThere is extensive medical literature that supports the efficacy and value for both EM as a medical specialty and for emergency patient care delivered by trained EM physicians.

Emergency departments in The Netherlands: is there a difference in emergency departments with and without emergency physicians? a cross-sectional web-based survey

“…More than 50% percent of the training program takes place in the ED, and there are three compulsory courses: Advanced Trauma Life Support (ATLS), Advanced Life Support (ALS) and Advanced Pediatric Life Support (APLS). Although the literature states otherwise, some medical specialties in The Netherlands still question the need for an Emergency Medicine specialty [4,8-17]. Despite the rapidly growing number of EPs in the Dutch EDs, there are still EDs that do not have EPs.…”

State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006

“…This proportion is higher than in other European countries such as Denmark (54%) [34], but closer to others like Slovenia (100%) [35]. A substantial body of literature highlights the benefits of EM-trained physicians for the care of critically ill patients [36,37]. However, a large proportion of Swiss EDs have such a low volume of patients that a dedicated team of ED physicians is not clinically or financially feasible; this problem has also been reported in other countries [38].…”

Hoping for a domino effect: a new specialty in Sweden is a breath of fresh air for the development of Scandinavian emergency medicine

“…A key part of the solution seems to be to having EM specialists on the floor and in the leadership of the EDs: Having EM specialists have been shown to improve efficiency, quality and cost of care in numerous studies [3,4]. The concept of emergency medicine must now be considered an essential part of modern, high-quality emergency care.…”