ADMIN & CLINICAL OPERATIONS
Integrating Public Health with Emergency Department Care
SAEM PULSE | JULY-AUGUST 2022
By Tehreem Rehman, MD, MPH, on behalf of the SAEM ED Administration and Clinical Operations Committee
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As emergency physicians, we see every patient that walks through the door no matter what language they speak, what their insurance status is, or whether they are a citizen of this country. The emergency department subsequently acts as a safety net setting for patients, especially those with complex social needs. Serving on the front lines of the community, emergency physicians are inevitably interacting with public health whether they realize it or not. I hope that at the end of this article, you will come away with a better understanding of how to leverage public health principles to your benefit to improve the experience and well-being of both patients and physicians in the emergency department.
Similar to how a patient’s vital signs provide us with significant information about the patient’s physical status and risk for potential decompensation, “community vital signs” entail a more holistic inclusion of structural determinants of health to fully understand the factors driving a patient’s clinical presentation. These “community vital signs” include both individual-level structural determinants of health data and population-level data such as the Social Vulnerability Index derived from U.S. Census Bureau data. However, as we become more sophisticated with clinical informatics and information exchange systems, we will likely have the capacity to use more real-time data.
One recent study found that data from 211 helpline calls may be more effective for risk stratification of patients with high emergency department (ED) utilization compared to more aggregate and less dynamic measures such as U.S. Census Bureau data. Incorporation of “community vital signs” into electronic health record data can help optimize understanding of all factors that inform the patient’s clinical presentation, treatment adherence, and ability to appropriately follow up. Thus, integrating public health with emergency department care allows physicians to successfully deliver “context-informed care,” ideally improving both health outcomes and patient satisfaction in the long term.
