The Division of Public Health Research is the most recent addition to the research structure of the Department of Emergency Medicine.
This formal designation was made in response to the increasing interest of departmental faculty in the investigation of emergency medicine’s potential role in shaping the health of populations rather than simply responding to the acute disease states of individual patients.
The notion of our specialty assuming a mission of public health intervention remains novel and controversial. However, the University of Cincinnati Department of Emergency Medicine is leading our specialty into the future in this new focus area in a manner reminiscent of the department’s past research successes.
Those most at-risk for adverse outcomes from preventable illness are assumed to be least likely to interact with the traditional health system.
Unlike outreach programs seeking target populations for intervention in the community, emergency departments passively receive patients in a medical setting where an opportunity for interaction exists.
Emergency departments routinely care for people from every background, socioeconomic group, and health status, and the emergency department is a key component of the health care safety net.
Even for those who can use health insurance to access health care, risky behaviors often bring people to the emergency department in unanticipated situations that may constitute a teachable moment. Patients have been shown to accept preventive services and value counseling during emergency visits.
The emergency department is therefore increasingly recognized as an ideal location for public health programs.
The Society for Academic Emergency Medicine (SAEM) Public Health and Education Task Force has advanced a rationale for expanding prevention services into the emergency setting.
- EDs already perform some prevention services such as tetanus immunizations. It is unclear why other equally effective practices should not also become standard of care.
- EDs are often the only source of prevention services for a highly vulnerable population without other health care access. Simply using the ED correlates with lack of some preventive services.
- Unexpected circumstances leading to ED encounters often constitute a teachable moment, potentially making prevention interventions even more effective than they would be in other settings. Several ED interventions targeted at high-risk populations have been shown to be effective.
- Unmet prevention needs will result in more ED visits of even higher acuity. In one study, 55% of patients with pneumococcal bacteremia had been seen in the ED within the 72 months prior, and almost all met criteria for vaccination at that time. 10% eventually died during their hospitalization.
Despite the many improvements in public health that could result from expanding the emergency medicine mission, implementing necessary changes remains controversial. The primary barrier is lack of time and resources.
Paradoxically, but not surprisingly, EDs treating populations most in need of such programs have the fewest resources to do so, and the SAEM task force has affirmed that the desire to expand emergency department-based public health programs should not detract from the primary mission of providing acute medical diagnostic and stabilization services.
Rigorous investigation and dissemination of research findings will be required to 1) engender motivation to overcome obstacles to the inclusion of public health interventions in the emergency medicine mission, and 2) influence allocation of limited national resources in favor of emergency department programs.
In this manner, it is anticipated that sufficiently powerful investigation will in the long-term be sufficient to translate research findings into practice, thereby changing fundamentally both emergency medicine and the national health system.
The ways in which emergency departments might endeavor to influence public health are many. While illness prevention is certainly a primary goal, there are many other issues such as bio-surveillance that have recently garnered national attention.
While no accepted classification scheme exists, broad categories might be constructed.
||Linkage to subsequent care
||Access to care and safety net issues
With the development of the Division of Public Health in the Department of Emergency Medicine, it became important to recognize the public health implications of other departmental research efforts.