Emergency medicine teams: Agents of change

Emergency medicine’s historical role as an agent of change was the keynote presentation at North York General Hospital’s 20th Emergency Medicine Update Conference. The largest event of its kind, the 20th anniversary brought together physicians for state-of-the-art patient simulations, interactive workshops and video-conferenced sessions to urban and rural Canada.

“Emergency Medicine Update is one of the best CME events in the world,” said Dr. Letovsky, renowned emergency medicine leader, educator and chief of Emergency Medicine at Credit Valley Hospital. “High caliber CME events like these help us create a cohesive community so we remain responsive to changing needs and superb practitioners.”

Dr. Letovsky highlighted how far the specialty of emergency medicine has come, and its current challenges. He characterized the progress in emergency medicine as moving from the ‘Age of Chicken Little’ to the ‘Age of Advocacy.’

According to Dr. Letovsky, the strength of emergency medicine’s culture lies in the advocacy of its staff. The way in which these health-care professionals think and behave is transforming care for the benefit of patients. Emergency Medicine gains respect through their advocacy, dedication and forward-thinking vision that challenges cynicism and embraces the challenges that are part of the emergency room experience.

“Being an advocate is a vital function of the emergency team. It involves being an advocate for the patient and for improving patient care. You have to trust that there is no one better at assessing emergency and urgent problems as the emergency physician,” said Dr. Letovsky.

Emergency physicians cannot be agents of change if they are cynical or if they aren’t persuasive advocates. This is one of most important attributes of a good emergency room physician, said Dr. Letovsky. You may need to urge a specialist to see a patient, or fight for access to scarce and limited patient resources like neurosurgery. You may even have to be a champion, internally and externally, for the resources you need.

During the Age of Chicken Little, emergency teams championed cutting-edge processes and treatments that other specialties cautioned against, believing the “sky would fall,” Dr. Letovsky suggested. Emergency physicians advocated improving how patients were sedated by using drugs that provided for a faster and better recovery – drugs that anesthetists resisted at the time.

Today, there are similar debates happening across Canada around the use of emergency department ultrasound. This modality gives emergency doctors huge advantages in the assessment and diagnosis of patients.

“Emergency department ultrasound is coming and will transform the way emergency physicians practice in the next decade,” according to Dr. Letovsky. “Our graduating residents are being trained in ultrasound and expect to use it. This is one more instance where we proved emergency medicine can use a new modality that meets safety and quality standards, and results in enormous benefits for our patients.”

These advocacy efforts can impact the future of emergency medicine. Certainly, as the baby boom generation comes through our doors, we will require the political will to advocate at all levels for needed resources.

“By 2031, 25 per cent of the population will be over the age of 65. We aren’t prepared today to meet the needs of this population that typically has complex multisystem diseases, higher acuity and longer emergency stays,” Dr. Letovsky stated. “We don’t know if there will be enough future graduates to meet these demands, and recent trends with closed emergencies and shifts not covered are certainly discouraging. There is already a shortage of nurses that is predicted to get worse.

Despite these challenges, emergency medicine is an extraordinary profession with great rewards and successes we can all be proud of,” said Letovsky, who received a standing ovation during his recent presentation. The rewards include teamwork, diversity, intellectual and scientific rigour, and evolving diagnostic trends and therapeutic options. And last but not least, the inestimable gratification that comes from medical interventions that save the lives of critically ill patients.