Cost Savings in the Emergency Room

My Soap Box Gets a Spotlight

Last week, I was browsing through the 12,427th article about the Affordable Care Act (ACA), more affectionately known as Obamacare. There was a whole section of the Wall Street Journal devoted to health care, and in particular, an article by Barbara Sadick titled, Emergency in the ER: Too Many Tests.

As I read through the article, the author covered many important topics, such as:
1. The overuse and increasing use of imaging (MRI and CT scan) in the ER, rising from 5% to 17% utilization per visit over a ten-year period (2000-2010)
2. The unnecessary exposure to radiation (a CT scan can deliver 100 times more radiation than a conventional X Ray).
3. A great quote from a director of clinical research in emergency department medicine. Dr. David Newman says: “In our medical culture, doctors often talk about what more could have been done, but rarely talk about what less could have been done.”

All good and important information, but my eyes widened a bit when the author steered into giving an example of obvious waste and inefficient care. Ms. Sadick quoted Dr. David Newman-Toker regarding his studies on management of dizziness in the ER. Those of us in the vestibular business, or those of you who have gone to the ER with the complaint of dizziness are aware of the typical assessment process, but this was covered in a mainstream national newspaper. I won’t go into the specifics of Dr. Newman-Toker’s study, because I have covered this topic in depth previously on this blog here and here, and more recently, here and here. I guess this really is a soapbox for me.

In the last of the four blog posts linked above, I ask the question, “Is anybody listening?” It appears that finally, some people in the mainstream are listening. The next step is to figure out how to educate ER Physicians. This could start with a clinical practice guideline for the assessment of acute vertigo. We did a practice guideline for BPPV a few years ago, so we know that gathering and publishing the evidence is only half the battle. We need the government to fund education programs for ER Physicians. The Wall Street Journal article states that half a billion dollars a year could be saved just by changing the way dizzy patients are assessed in the ER. Other studies I have read put it closer to $1 billion. An education program would cost far less than 1% of those numbers, yet to my knowledge there is no movement in this direction.

Okay, I am down off my soapbox now.

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.