 PDF Version |
Triaging the Emergency Care System
In recent years, there has been a major push to better integrate the efforts of the wide variety of federal agencies that do similar work, bringing together the many different offices and organizations that have been created to coordinate national defense, intelligence, financial oversight and yes, even emergency care.
In 2006, a report from the Institute of Medicine (IOM) recommended a federal lead office be created to focus and coordinate federal efforts relating to the emergency care system. As a result of this, then-President Bush signed the Homeland Security Presidential Directive #21 dealing with public health and medical preparedness which created the Emergency Care Coordination Center (ECCC), an office in the Department of Health and Human Services. The directive deals in large part with developing and improving public health, as well as increasing our nation’s capacity to handle a medical disaster. Developing and maintaining our nation’s emergency care system is a critical part of ensuring we are prepared for any response efforts to a disaster or crisis.
“Many fail to realize that the emergency care system permeates many different aspects of the federal government – including the Departments of Defense, Transportation, Veterans’ Affairs, Homeland Security, and Health and Human Services,” said Michael T. Handrigan, MD, FACEP, director of the ECCC in Washington, D.C. “While each of these organizations have programs that involve or engage the emergency care system in some way, previously there had been no federal agency primarily concerned with coordinating the issues affecting the emergency care system.”
Coordinating the Nation’s Emergency Care
Since its inception the ECCC has been focused on laying the groundwork for a manageable, 21st century national emergency care system. Working with stakeholders and policymakers Dr. Handrigan and his team have partnered with the National Quality Forum (NQF) to explore a framework for developing and endorsing quality care measures in the emergency care system.
“Part of the IOM’s report suggested the need for a regionalized approach for the emergency care system as well as a stronger system of accountability, which means having the right metrics to accurately and objectively determine how things are functioning in different emergency departments. “Through our work with the NQF, we are developing metrics we hope will fill this role, and will help us foster the sort of regional, measurable and accountable emergency care systems that everyone agrees we so desperately need.”
Dr. Handrigan also says that the area in which the ECCC should be able to make the biggest impact is by creating and fostering awareness in the federal government of the need to align programs that deal with the emergency care system. “If we bring our federal partners together so they can more effectively collaborate, we can have a meaningful effect on the state of emergency care in America
The ECCC also is working to create awareness within the greater health care community regarding the role and function of the emergency care system.
“Our nation’s emergency care system serves as the point of entry into the health care system for a large number of people,” said Dr. Handrigan. “Those who are not directly involved may not appreciate the immense burden we place on the system everyday – as well as the absolutely critical role we expect it to play in the wake of a crisis or disaster.”
Dr. Handrigan acknowledges that the ECCC cannot tackle every issue confronting emergency care, and says the challenge is to find areas where they can feasibly make changes and improvements, while ensuring their work is as meaningful as possible.
“Some might view the ECCC’s role as refocusing the federal government on emergency care system issues, but I prefer to think of it as providing the federal government with an opportunity to find focus. We are not going to be taking over the jobs of any of our federal partners,” said Dr. Handrigan. “Rather, in a post-Affordable Care Act world, it is critical for our government to be able to identify opportunities to collaborate, leverage, and align the myriad of organizations and agencies who work with and around emergency care, in order to create a federal agenda for the entire emergency care system.”
This, it would seem, is the ECCC’s mission, and while they have more work to do, they seem to be off to a very good start. While their challenges are daunting, the opportunities they have to strengthen our nation’s emergency care system are great.
Danielle Lazar, MA, Research Associate, Center for Health Care Quality, Department of Health Policy, The George Washington University
