Here are a few questions to ask your colleagues at your next department meeting as you look at the data relevant to the patient population you are serving:

1. Do you see enough elderly patients? Perhaps it is time to think of developing a geriatric ED service line to meet their needs? Could this be done in a clinical decision unit to allow for enough time to fully evaluate complex patients? Do you have enough case management support for these patients? Is your department friendly for seniors in terms of its design and amenities? Do you have care process models in place for common or acute geriatric diagnoses like stroke, hip fracture, and medication-related issues? Do you need to look at nursing home transfers?
2. Have your processes, staff, and patient flow kept pace with the behavioral health needs of your community? Do you need a small behavioral health unit? Do you have ample support staff in the form of crisis workers and social workers with psychiatry backup? Do you have policies and protocols in place for managing potentially violent or suicidal patients?
3. Do you have appropriate service lines for your pediatric population? This may include things like a bronchiolitis clinic during the winter months and croup protocols. Would it make sense to flow most pediatric patients through your fast track (low-acuity zone) in lieu of the loss of other accident and injury patients?
4. Have you recognized the ethnic and cultural needs of your community? For instance, do you have information for common ED conditions in the languages represented by your community? Should you recruit for ethnic and minority representation in your ED team?

The bottom line is this: you need to know who is coming and you need to prepare for every subset of patients. By studying national trends and capturing this data locally, we can optimally prepare for the needs of the communities that we serve.

Dr. Welch is a practicing emergency physician with Utah Emergency Physicians and a research fellow at the Intermountain Institute for Health Care Delivery Research. She has written numerous articles and three books on ED quality, safety, and efficiency. She is a consultant with Quality Matters Consulting, and her expertise is in ED operations.