SAEM PULSE | JANUARY-FEBRUARY 2022
Emergency Medicine’s Role in Home-Based Care
22
By David Whitehead, MD; Emily Hayden, MD; Benjamin White, MD; Brian Yun, MD; and Stephen Dorner, MD, on behalf of the SAEM ED Administration and Operations Committee
Background
As hospitals nationally struggle with capacity challenges, emergency department (ED) crowding has worsened again, increasing demand for alternative ways to care for patients. ED observation units (EDOUs), once thought of as an “alternative” care pathway, have grown significantly in number and provide care for patients needing prolonged monitoring and/or additional testing. Now mainstream, the growth and success of EDOUs have
demonstrated that they can preserve ED resources and provide financial benefit to hospitals. Amidst the COVID-19 pandemic, in recognition of constraints on in-hospital space, the Centers for Medicare and Medicaid Services (CMS) launched the Hospital Without Walls (HWW) waiver authorizing the use of telehealth and non-traditional spaces such as patients’ homes to provide what has historically been hospital-based care. Enterprising EDs have seized on the opportunity
created by CMS to expand their clinical skill set into alternative sites of care via mobile urgent care and virtual observation units.
Model
Extending the reach of emergency medicine (EM) beyond the walls of the hospital and into patients’ homes is possible through a mobile integrated health (MIH) care platform: pairing a specially trained paramedic with portable diagnostics and therapeutics with real-time medical direction from
