When the Warren Alpert Medical School at Brown University hosted the 17th annual New England regional meeting of the Society for Academic Emergency Medicine on April 3 at the Rhode Island Convention Center, Dr. Brian Zink was one of the speakers.
Zink is chair of the department of emergency medicine at Rhode Island and Miriam hospitals, president of the University of Emergency Foundation, and a professor of emergency medicine at the Brown medical school.
Providence Business News asked Zink to share his insights about the challenges and changes shaping emergency care in Rhode Island.
PBN: How is the advent of texting and smart phones and social media changing the interface with patients seeking services in emergency rooms?
ZINK: Texting, smart phones, and social media can facilitate emergency care. Some emergency departments provide wait times via text; others have “apps” to help potential patients decide whether they need an ED visit; and Twitter can provide real-time “ratings” of ED care.
Excitingly, they are increasingly used to improve post-discharge care. Emergency physicians at Rhode Island Hospital are investigating ways to improve patient compliance and engagement via text messaging.
Of course, they also impact care “in the moment,” as patients are often actively dialoguing with friends and caregivers, via their phone, at the same time that they’re being evaluated in the ED.
Beyond Cash Donations: How New Forms of Giving Are Transforming Not-for-Profit Accounting
Evolving Funding Landscape for Not-for-Profits Not-for-profit organizations are being asked to do more with less,…
Learn More
PBN: Much of the impetus of cost-cutting through health care reform has focused on decreasing the number of emergency room visits as a way of controlling costs. From the perspective of an emergency room doctor, is that a valid contention? Is it more that the lack of accessible care for patients with chronic diseases and behavioral health problems puts an unfair burden on emergency rooms?
ZINK: Emergency departments have been the safety net for a dysfunctional health care system for 30 years. The reason for high ED utilization in Rhode Island for those with commercial insurance and Medicaid or Medicare is that EDs are open 24/7, they have highly trained physicians and staff, and they rapidly solve medical problems.
And, for thousands of people who lack real access to primary care or psychiatric care, EDs are the only alternative for acute illness or injury.
Our recent analysis shows that EDs account for 6-8 percent of health care costs. We are partnering with insurers, primary care physician groups, and the state in innovative programs to try to reduce unnecessary ED use and hospitalizations and costs, while at the same time making sure that we are always ready for the community in times of acute crisis.
PBN: The number of drug overdoses treated by emergency rooms in Rhode Island from prescription painkillers has reportedly increased in recent years. In your experience, is that accurate? Are there new protocols in place to deal with this?
ZINK: Rhode Island has unfortunately not been spared the national trend of increasing misuse and abuse of prescription drugs and the incidence of drug-induced deaths surpassing that of traumatic deaths in the last several years.
We have not only been seeing increases in these drugs, but also in the usual drugs of abuse such as cocaine, heroin and amphetamines as well as the newer synthetic drugs, including “bath salts” and fake marijuana.
Part of the training in emergency medicine relates to the identification and management of the wide variety of overdoses and substance misuse. At Rhode Island Hospital, we have the only board-certified medical toxicologist in the state on staff – Dr. Jason Hack. He coordinates and updates our existing protocols to manage overdoses, and we have needed them to handle some of the more violent and aggressive patients with bath salt or fake marijuana intoxication.
We have a special unit at the hospital’s Anderson Emergency Center dedicated to optimizing the care of drug and alcohol intoxicated patients.
PBN: Emergency rooms are also a place where doctors encounter domestic violence. Does new access to EHR records at the point of care provide an opportunity to develop new protocols?
ZINK: The U.S. Preventive Services Task Force recommends that all patients be screened for domestic violence. This often doesn’t happen in practice, for a variety of reasons.
Computerized screening for domestic violence (and for other forms of violence) offers tremendous potential benefits – it is universal, unbiased, and confidential.
Of course, with any disclosure of domestic violence, maintaining patient confidentiality is of the utmost importance. Providers need to maintain safeguards so the patient doesn’t experience repercussions should their partner see their EHR.
PBN: The issue of gun violence is something that emergency rooms must confront in the context of treating the victims and attempting to save lives. Is there any way to quantify the costs associated with treating victims? Does any hospital in Rhode Island currently track the costs?
ZINK: We treat victims of gunshot wounds on an almost daily basis at RIH Anderson Emergency Center. Most people are not aware that current federal laws restrict research on the costs of gun violence. The last high-quality study on U.S. costs of firearm injuries was conducted in 1997, when gun-related injuries’ medical costs were estimated at $2.3 billion per year.
However, this looked at just hospital charges, and that provides an inaccurately low value for the true cost of a firearm injury, as it doesn’t account for follow-up care, psychological trauma, and long-term disabilities.
Hopefully, with the President’s recent lifting of the 1997 federal ban on firearm research, we will once again be able to accurately quantify the costs of gun-related injuries in our state and on a national level.
