Three interconnected trends are reshaping both the emergency department and emergency medicine: the aging of the population, growth of chronic disease, and the move from inpatient to outpatient care. These older patients are more complicated and require complex evaluation and treatment. The disposition mindset has reversed. In the past, we admitted patients to have them worked up. Now, these patients are worked up to determine if they need to be admitted. As a result, emergency physicians are increasingly the decision makers for hospital admissions and have expanded their scope to manage observation units. These trends will likely continue and grow to include more telehealth, telemedicine, admissions to “hospital at home,” and placing satellite emergency departments placed in the communities closer to the patients.

Emergency medicine can look back at 50 years of change and recognize that our growth and advancement are underscored by the profession’s commitment to the needs of patients and communities. It has always been this way and always will be.

Dr. Martinez is chief medical officer for Adeptus Health in Irving, Texas; assistant professor of emergency medicine at Emory University in Atlanta; and an ACEP Now editorial board member.

Reference

1. Shortliffe EC, Hamilton TS, Noroian EH. The emergency room and the changing pattern of medical care. N Engl J Med. 1958;258(1):20-25.
2. National Academy of Sciences and National Research Council Committee on Trauma; National Academy of Sciences and National Research Council Committee on Shock. Accidental death and disability: the neglected disease of modern society. Washington, D.C.: National Academies Press (US); 1966.