(cross posted at freeforall)
Bill Gardner has a nice post on the use of Emergency Rooms (ER) for non-emergent care. Such use clogs the ER and is an expensive way to deliver basic care. However, many poor persons have no viable alternative. This is an old problem, and providing everyone with health insurance will not fix it. We need a care delivery innovation of some sort.
I have been considering investing in a food truck in Durham; the many food truck options in and around Durham, NC make me think that I have already missed the investment wave. However, my analysis has lead me to wonder if the food truck concept could be a useful way to address the use of ERs for non emergent care.
The best food trucks I have visited provide good quality food at a relatively low cost, typically by consistently providing a narrow range of fare, and showing up where the customers are when they want to eat.
In the same way, if Duke University Health System had an “ER on wheels” (or several) they could provide basic care at a lower cost than they do at the Duke ER, and could go to where the patients were. In fact, one set up just outside of the entrance to the ER might be the first place to start. After that, you could imagine a twitter-driven service in which The Duke ER trucks broadcast their locations; potential patients could tweet or facebook them and say “can you come near the intersection of X and Y street, I think my 10 month old may have an ear infection and I need to figure out if I have to call out sick from work tomorrow”. Patterns of use would emerge. Even if you assumed everyone using such an ER truck was uninsured (they wouldn’t be if competent care could be delivered quicker and cheaper than that at the ER), then it would be advantageous to Duke to undertake something like this so long as the cost was less than their cost of providing care to the uninsured in the ER.* And what patient wouldn’t want to avoid an hours-long wait in the ER?
You can definitely deliver health care via a truck or bus as Hangoverhaven is demonstrating in Las Vegas.
Our facility is open seven days a week from 8 am to 4pm. We have a shuttle that can come pick you up and drop you back off. We have a special WSOP package that is one bag of IV fluids, IV vitamins, and IV glutathione. Glutathione is an antioxidant that also supports mental function. I have been using it the last few weeks with clients and have noticed a significant difference. The WSOP package is priced at $99.
Now, no matter what you think of this service (they take reservations!), it is a case of taking the care to where the people are (Vegas Strip) and addressing their felt needs (they really feel them). And Dr. Jason Burke, the doc/entrepeneur who started this business is a Board Certified Anesthesiologist who trained at Duke. Maybe we need to get him back here for a consult, and see if a mobile ER might not provide quality care while both reducing costs and improving patient satisfaction.
I am being totally serious. When you see the same problem over and over (use of the ER for non emergent care), you need an innovation of some sort.
*I had a surprisingly hard time finding the value of uncompensated care that Duke University Health System says it provides via its Emergency Room, meaning I can’t find I number whose source I understand; I will update when I can dig it up.
Tags: Emergency Room Use, Innovation
“Emergent” has a meaning, and it isn’t, “has to property of being an emergency”.
emergent /emer·gent/ (e-mer´jent)
1. coming out from a cavity or other part.
2. pertaining to an emergency.
Dorland’s Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
Or Donne, “Devotions upon Emergent Occasions”.
And Brett’s spectacular record of never being in the same room as an actual fact continues!
http://www.merriam-webster.com/medlineplus/emergent from Medline is “calling for prompt or urgent action- an emergent condition in a hemophiliac.”
Stedman’s Medical dictionary 28th edition is similar to Dorland’s : Arising suddenly and unexpectedly, calling for quick judgment and prompt action. 2. Coming out; leaving a cavity or other part.
This is everyday usage among doctors and other health care providers.
The trick is going to be knowing what to have in the mobile unit, but, since “common things are common,” a set of mobile supplies and equipment could be developed and refined.
Not having something and then suddenly needing it in a mobile unit could create some nasty legal liabilities if there are not laws to limit them.
Just because if you persist in back formation long enough descriptionist dictionaries will eventually record it, doesn’t mean you should engage in back formation. You’ll find “surveil” in some dictionaries now, too; Should you use it?
The usage is attested in the OED as well:
. Used for ‘urgent’, ‘pressing’.
1706 D. Defoe Jure Divino Pref. p. i, To perswade their Princes to trust them in their most emergent Occasions.
1718 Lady M. W. Montagu Let. May (1965) I. 410 The most emergent necessity.
1878 Macmillan’s Mag. Jan. 254/1 Certain petty and emergent repairs.
1881 Spectator 19 Feb. 245 The provocation was of the most emergent kind.
1882 R. Temple Men & Events viii. 182–3 If a matter was politically emergent‥he cast away his over-caution.
After all, who am I to argue with Lady Montagu?
Ed,
206 years isn’t a long enough back-formation, doncha know?
Brett,
Dictionaries document current usage, they do not dictate it.
Nah, I guess 206 years is long enough. Still grates on the ears, though.
I can live with “emergent,” and as a writer on health care research, I have little choice. What drives me crazy is the (primarily social science) use of “actionable” to mean an idea or plan that can be acted upon. I still remember the more common (legal jargon) usage of “actionable” as something that is the source of a lawsuit.
Whenever I hear or read the desire for “actionable” ideas or findings, I always hope that they are not truly so.
I have long wondered why hospitals don’t put an urgent-care facility near their emergency room, and direct everyone there for triage unless they’ve already been triaged via a paramedic.
Hangover Heaven? That’s a genius idea. Or a scam, I’m not sure which.
Most of the ill-effects of a hangover are due to dehydration. The really important component is the liter of fluids in the bag. The water-soluble vitamins (B complex, C, K) don’t hurt and might help. I’d want to see the results of a properly blinded randomized trial of glutathione before I buy into that claim.
The body synthesizes glutathione from its component amino acids (glycine, cysteine and glutamic acid); on the other hand, alcohol metabolism proceeds via oxidation to acetaldehyde. Acetaldehyde is pretty unstable and does release free radicals. So, maybe, a serious bender could deplete the liver’s stores of antioxidants. Color me skeptical about the additives. There is too much room for placebo effects.
But in terms of a business model, it’s genius.
Also note that dehydration of someone who’s drunk too much (but is conscious and rational enough to pay these people $100, or to fulfill an earlier appointment) can be combated with glasses of water, involving no medical procedure, no blood, no great expense, and no unsupported quackery about glutathione. If you want to be fancy, put some vitamins and some glucose in the glass of water.
That’s too simple a solution — like the one I used then (and still use) when I imbibe alcohol: I keep a glass of soda along with the drink, and drink 1 1/2 or 2 glasses per mixed drink.
Besides, there’s no placebo effect from that solution.
Doesn’t this notion rather fall down on the requirement under current law (at least here in LA county) that anyone who calls an ambulance is transported to a hospital for treatment as if it were a genuine emergency and performed by real doctors, even when the responding EMTs are pretty sure they’ve taken care of the situation or that none even exists?
Sure, you could just eliminate that requirement - but the requirement is there for a reason. I’m not convinced you could eliminate the requirement without seeing some tragic consequences, especially for the poor and for those with poor communications ability (for reasons of language, of education, or of temporary or permanent cognitive impairment).
And it’s amusing that you’re basing your idea for responsible medical care on the basis of exploitative bottom-feeding for-profit cowboys like Hangover Heaven …
Brett,
You don’t get to be an expert on English usage by pulling it out of your ass. Try Ghits, or try searching an acceptably large corpus, since actually consulting a dictionary seems beneath you.
Or, y’know, you could put clinics in neighborhoods where lots of people need healthcare and don’t have access to it. Or just park the bus/truck/whatever at different known locations on different days of the week, and you’d cover the vast majority of needs.
All of this used to be done in large and medium-sized cities, but we stopped funding it because it was too expensive. Talk about Berra’s Law…
(1) Libraries have bookmobiles.
(2) In urban areas we find commercial (i.e., for profit) 24-hour-care facilities, which my wife calls “Doc-in-a-box.”
So it seems like the two ideas could be combined in “Docmobiles.”
A number of interventions already employ these types of mobile vans. For example some syringe exchanges have mobile vans that include a nurse or physician assistant to help with minor health emergencies such as abscesses. It’s cost effective and it ultimately saves money for the state, emergency rooms etc. However, I suspect that one reason that ERs don’t fund them is that they lower a barrier to care so many folks who just don’t get treated and either get better or don’t end up getting cared for by these sorts of interventions. Additionally in the case of syringe exchange there are politicians who have decided that somehow it is immoral because it interferes with zero-tolerance messaging in the war on drugs (no evidence ever provided).