PRESIDENTS MESSAGE

TRANSFORMING EMERGENCY CARE

DELIVERY WHAT DOES THE FUTURE HOLD?

Diane Gurney, RN, MS, CEN,

Hyannis, MA

NAs 40th Anniversary Year theme is Transforming

Care Together. The Joint Commission has even
created a promising Center for Transforming
Health Care. Transformation, not just change, is the word
of the day, which begs these questions: What will the transformation of emergency nursing look like over the next few
years? What are some of the challenges? And, how will we
handle the increase in patient volume brought about by
health care reform, or the Patient Protection and Affordable Care Act (PPACA) of 2010, in an already overburdened emergency care system? The problem will be
exacerbated for emergency departments, already in crisis.
A few of the issues that will influence the transformation
are systems development, technology, data collection to help
identify best practice, and increased demonstration of competency. With regard to systems development, we often hear
the term regionalized care, but in order to regionalize care,
you must have a system. Hospitals first began developing systems by partnering with one another to better leverage buying power from suppliers and then found it beneficial to
partner for sharing of services. Trauma systems in some states
became the model for a system of care from pre-hospital trauma triage criteria through patient re-entry into the community. The care of cardiac and stroke patients also drove some
hospitals to partner for improved care. Expanding on the use
of these systems may benefit the continuum of care.
I recently attended the Emergency Department Practice Management Association (EDPMA) Solutions Sum-

Diane Gurney is President of the Emergency Nurses Association.

For correspondence, write: Diane Gurney, RN, MS, CEN, 261 Bishops
Terrace, Hyannis, MA 02601; E-mail: mermaid6@comcast.net.
J Emerg Nurs 2010;36:395.
0099-1767/$36.00
Copyright 2010 Emergency Nurses Association. Published by Elsevier Inc.
All rights reserved.
doi: 10.1016/j.jen.2010.08.010

September 2010

Volume 36 ISSUE 5

mit, where the focus was innovative, practical strategies.

One speaker suggested that rather than the old treat and
street mentality, a more likely scenario of the future would
be treat and connect, providing a safe hand off to the
community. With a shortage of primary care providers,
patients with accessible community health entities managed by nurses and supported by primary care providers
with hospital-admitting privileges could transform our process for patient discharge. Think of how many vulnerable
psychiatric patients we discharged without anyone to tell
our plan for patient safety or compliance. These health care
entities (yet to be identified or defined) could provide wellness visits, patient education, monitoring, and possible
reduction in unnecessary hospital readmissions. Prevention
and safety will be watchwords for the future, and emergency nurses, who are already recognized as leaders in
injury prevention and health maintenance, will be key.
As for technology, hand-held electronic devices provide immediate access to vital information, and computerized machines distribute medications and supplies. A
shortage of specialty physicians in community hospitals
has driven them to partner with tertiary centers for the
development and use of telemedicine. Have you seen a telemedicine exam from a remote area when the otoscope
actually views the human ear and a stethoscope placed on
the chest of a patient transmits heart sounds? This could be
incorporated into emergency care. What other types of
devices and technology are being employed? One hospital
in New Jersey is using palm vein scanning for identification. Another health care system uses a monitor for blood
samples that sends an alarm to providers that the blood
sugar is abnormal. Telemedicine calls also help maintain
psychiatric patients in their homes.
The transformation to excellence will be built on data
and benchmarking, and emergency nurses will be essential
not only to provide data, but to effectively identify and
articulate best practices. The front ends of emergency
departments are being re-engineered across the country.
Will triage become pass?
And, last but not least, practice excellence will be at
the core of this transformation of care, so certification and
specialty scope and standards of practice will become even
more valued. It may be difficult to define the future of
emergency care at this point, but future goals are becoming clearer and skilled emergency nurses with their unique
scope of practice can lead this transformation in the coming decade.

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