We have a big problem in EM that lies outside the walls of our departments: Our health care systems are failing. This is having profound effects on the daily operations of EDs around the world. Packed waiting rooms, treatment delays, poor patient outcomes, frustrated families of patients, EM provider burnout and ED closures. In order fix EM, each of us needs to understand systems issues and systems thinking, and advocate for a better system based on sound systems principles and specific solutions. In this main episode EM Cases podcast Anton is joined by Dr. Alecs Chochinov and Dr. Davie Petrie, two systems thinkers and leaders in EM. They discuss solutions for how to fix EM in 5 spheres: having a coordinated mission, optimizing access points, accountability, disaster preparedness and adaptation/evolution. They answer questions such as: What can we glean from how EM has evolved in the last few decades to help shape the future? How can we utilize virtual care to make it work for us and our patients well? How can we improve our EMS systems? How can we change the system to prevent emergency provider burnout? How can we integrate systems thinking into the daily operations of EDs to improve patient flow and outcomes? and many more...



Podcast production, sound design & editing by Anton Helman

Written Summary and blog post by Anton Helman February, 2024

Cite this podcast as: Helman, A. Chochinov, A. Petrie, D. The Future of EM - Systems Thinking. Emergency Medicine Cases. February, 2024. https://emergencymedicinecases.com/future-of-em-systems-thinking. Accessed December 25, 2024

Résumés EM Cases“Waves of medical refugees are landing on our shores. With the decline and fall of their primary care home, they present to EDs with more co-morbidities and in ever greater numbers. Those requiring admission often face siloed services, quotas, ‘closed borders’; so, they wait, and those behind them wait, with predictable results.”

- Dr. Alecs Chochinov

The topics of discussion in this episode were gleaned from EM Power: The Task Force on the Future of Emergency Medicine Care report at the Canadian Association of the EM. The EM POWER task force is a team of Canadian EM leaders who developed a systems-based approach to the future of emergency care, where integrated networks with multiple access points–not just emergency departments–are responsive to patient needs and adaptive to changing conditions.

How did we get here? Historical background to help understand the present situation in EM

Recent history and the evolution of the specialty of Emergency Medicine within health care systems reveals 4 key pathologies:



* Population–capacity misalignment - with increasing and aging populations we have outstripped the capacity to take care of them

* Accountability failure - each service/program has failed to be accountable for their patients with patients ending up in the ED because they have nowhere else to go in a timely manner

* Lack of readiness - with most of our attention paid to efficiency rather than readiness/resilience, it is increasingly difficult for our system to handle surges in patients, pandemics and other disasters; we need to build in capacity, safe redundancies and optionality in our health care systems

* Complexity creep - our patients are getting sicker and more complex; patients that are categorized as low acuity are often high complexity