A survey of academic departments of emergency medicine regarding operationand clinical practice

Study objective: To survey academic departments of emergency medicine conce rning their operation and clinical practice. Methods: A survey was mailed to the chairs of all 56 academic departments o f emergency medicine in the United States requesting information concerning operations and clinical activity in budget year 1997-1998 compared with 19 95-1996. These results were then compared with a similar survey conducted i n the fall of 1996, examining the 1995-1996 academic year compared with the 1994-1995 academic year. Results: Forty-one (73%) academic departments of emergency medicine respond ed. For 1997-1998, compared with 1995-1996, 24 (59%) academic departments o f emergency medicine reported an increase in emergency department patient v olume; 10 (24%) reported a decrease. Twenty-four (51%) academic departments of emergency medicine reported an increase in ED patient severity, whereas 7 (15%) reported a decrease. Twenty-five (61%) academic departments of eme rgency medicine reported an increase in net clinical revenue for emergency medicine services, and 9 (22%) reported a decrease, Only 9 (22%) academic d epartments of emergency medicine reported other academic departments within their university/medical center aggressively directing patients away from the ED compared with 14(30%) in the previous study. The percentage of acade mic departments of emergency medicine using midlevel providers remained ess entially the same over time (68% versus 66%). In both studies, midlevel pro viders were used most commonly in a fast-track setting. Only 37% of academi c departments of emergency medicine reported having an observation unit; st affing in all cases was by emergency physicians. Since the last survey 38 ( 93%) academic departments of emergency medicine reported their medical cent er or hospital negotiating with managed care organizations to provide servi ces. Unfortunately, only 41% of chairs were involved in these discussions. Between January 1, 1997, and the 1998 fall survey, 29% of academic departme nts of emergency medicine reported their university merging with another un iversity system, and 19% reported such mergers being discussed. Similarly, between January 1, 1997, and fall 1998, 22% of academic departments of emer gency medicine reported their institution merging with a private entity, wh ereas 16% reported ongoing discussions. Conclusion: Academic departments of emergency medicine have experienced som e encouraging trends: an increase in ED patient volume, patient severity, a nd net clinical revenue during the study period. Midlevel providers continu e to be used primarily in fast-track areas of EDs. An area of potential gro wth for academic departments of emergency medicine is observation medicine, because only one third of academic departments of emergency medicine have such a unit. Academic medical centers have experienced a significant increa se in merger activity during the study period.