{"id":12458,"date":"2018-10-11T07:00:19","date_gmt":"2018-10-11T12:00:19","guid":{"rendered":"https:\/\/feminem.org\/?p=12458"},"modified":"2018-10-07T19:06:06","modified_gmt":"2018-10-08T00:06:06","slug":"expanding-the-reach-of-emergency-medicine","status":"publish","type":"post","link":"https:\/\/feminem.org\/2018\/10\/11\/expanding-the-reach-of-emergency-medicine\/","title":{"rendered":"Expanding the Reach of Emergency Medicine\u00a0"},"content":{"rendered":"<p>Yes, this is a piece on observation medicine as the expansion of our specialty.<span class=\"Apple-converted-space\">\u00a0 <\/span>My oh my, have things changes since my days of training where I learned to care for all comers irrespective of their money, background, color or creed.<span class=\"Apple-converted-space\">\u00a0 <\/span>I learned to stabilize, evaluate and treat then admit or discharge.<span class=\"Apple-converted-space\">\u00a0 <\/span>Clearly I\u2019m simplifying though, historically, our disposition decision was binary, patient in or out. <span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Then overtime as I practiced emergency medicine and grew in my career, I became exposed to the business side.<span class=\"Apple-converted-space\">\u00a0 <\/span>The business side is complex and includes payors, contracts, utilization reviews, denials, audits, and the often thin margin between making versus losing money for a hospital and healthcare system. <span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>So how did this become my world?<span class=\"Apple-converted-space\">\u00a0 <\/span>Well, I was given a unique opportunity to start an EM-run observation unit two years after finishing residency.<span class=\"Apple-converted-space\">\u00a0 <\/span>This was a risk for me as I had no formal background as to what observation even was and I was still \u2018young\u2019 in my career.<span class=\"Apple-converted-space\">\u00a0 <\/span>At that time, I was a new mom, newish wife, relocating to a new city.<span class=\"Apple-converted-space\">\u00a0 <\/span>Perhaps because of all the change and \u2018newness\u2019 around me, the entrepreneurial bone in my body asked, why not?<span class=\"Apple-converted-space\">\u00a0 <\/span>I would also like to give credit here to meeting an exceptional mentor who was supportive of me and she also exuded a \u2018why not\u2019 attitude.<\/p>\n<p>Over the next years, I\u2019ve gone through numerous observation service expansions and though there is an obvious business case for this, my passion has been to creating a new space for education and application of evidence based emergency medicine.<span class=\"Apple-converted-space\">\u00a0 <\/span>These are our bread and butter patient presentations.<span class=\"Apple-converted-space\">\u00a0 <\/span>We care for people with chest pain, syncope, asthma, COPD, cellulitis, dehydration, heart failure all the time and now can continue caring for them.<span class=\"Apple-converted-space\">\u00a0 <\/span>Moreover, we have expanded to care for more complex presentations like atrial fibrillation, pulmonary embolism, gastrointestinal bleeding, sickle cell pain crisis, TIA.<span class=\"Apple-converted-space\">\u00a0 <\/span>We apply rules and our EM gestalt for best practice patient outcomes. <span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Our observation unit is home to learners and teachers.<span class=\"Apple-converted-space\">\u00a0 <\/span>We have EM interns, medical students, APP students, social work students, occasional IM seniors spend time in our unit learning to apply evidence-based care and assure safe transitions in addition to just making the diagnosis.<span class=\"Apple-converted-space\">\u00a0 <\/span>Our teachers are also leaders in simulation, ultrasound, resident education, healthcare delivery research, performance and quality improvement, and community outreach.<span class=\"Apple-converted-space\">\u00a0 <\/span>We talk about what\u2019s next, does this patient need a test and why, we coordinate care so people have safer transitions to their homes or elsewhere, establish primary care, get them to a specialist or consult a specialty when it\u2019s not possible.<span class=\"Apple-converted-space\">\u00a0 <\/span>We even have a fellowship.<\/p>\n<p>So seven years later, another job opportunity, another kid, another new observation unit, here is what I would like to share.<span class=\"Apple-converted-space\">\u00a0 <\/span>The spectrum of emergency medicine is ever expanding.<span class=\"Apple-converted-space\">\u00a0 <\/span>We truly care for patients in ANY setting; during disasters, over-seas, in the wilderness, in urgent cares, through video interfaces, in your typical ED, AND in observation units.<\/p>\n<p>We are unique and our reach is expansive.<span class=\"Apple-converted-space\">\u00a0 <\/span>So no matter what your passion and what opportunities arise in this great field of ours, ask yourself \u2013 why not?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Yes, this is a piece on observation medicine as the expansion of our specialty.\u00a0 My oh my, have things changes since my days of training where I learned to care for all comers irrespective of their money, background, color or&#8230;<\/p>\n","protected":false},"author":502,"featured_media":12750,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_mi_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":"","_jetpack_memberships_contains_paid_content":false,"jetpack_publicize_message":"@MariaAini reflects on the expansion of Emergency Medicine over the years.","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[1,5],"tags":[730],"coauthors":[731],"jetpack_publicize_connections":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Expanding the Reach of Emergency Medicine\u00a0 - FemInEM<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/feminem.org\/2018\/10\/11\/expanding-the-reach-of-emergency-medicine\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Expanding the Reach of Emergency Medicine\u00a0 - FemInEM\" \/>\n<meta property=\"og:description\" content=\"Yes, this is a piece on 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