The emergency clinic - A study in its role in a teaching hospital

摘要

During the mid-twentieth century, the country witnessed a dramatic rise in emergency clinic (EC) use. This was recognized at Children's Hospital Medical Center, Boston, where EC visits surged to > 14 000 per year by 1960. An investigation was undertaken to examine patient characteristics, reasons for EC use, and how this expanding cohort of patients fit in the medical teaching model. Their finding that approximately 50% of children lacked routine primary care was worrisome in its financial and social implications. Many chief complaints were comparable with those seen in pediatrician offices rather than inpatient hospitals, leading the authors to suggest that ECs use these encounters to provide anticipatory care and address the underlying factors leading to over-reliance on emergency services. Furthermore, they recognized the untapped opportunity ECs provided for medical training.This study was performed in the pre-specialized era of pediatric emergency medicine. Pediatric visits to emergency departments (EDs) now approach 28 million per year, with larger centers such as the study site Children's Hospital Boston ED caring for >60 000 annually. Indeed, a 14 000 visits/year emergency clinic sounds quaint by today's standards. Despite the difference in scale, results of recent investigations demonstrate that many of the challenges from 50 years ago remain. Approximately two-thirds of visits are non-urgent, and lack of access to a primary physician continues to be a major factor for ED overuse.1 These established problems are compounded by emerging hurdles, including overcrowding, nursing shortages, and the potential effects of healthcare legislation.