The ER house call for the 21st century: Phil Mitchell at TEDxMileHigh (Transcript)

Walter is 72, has high blood pressure, high cholesterol, and mild dementia. He lives at home with his wife Betty. Walter’s been healthy in general, but has had a gradual decline and now needs some help with bathing and getting dressed. He picked up a GI illness and had pretty significant vomiting and diarrhea. When he couldn’t keep down any liquids, he became very dehydrated. He got up to go to the bathroom, felt weak and dizzy, and fell to the ground. Because the skin on his arms was so thin, he suffered from large skin tears on both of his forearms.

He was able to crawl back into bed, but Betty was concerned so she called 911, an ambulance arrived at their home, and Walter was taken to the ER where over the next six hours he had multiple blood tests, scans, and although they couldn’t find anything specifically wrong with him he was admitted to the hospital for observation.

Over the next two days, he started to improve but became more confused due to being in the new environment of the hospital, and he was still too weak to go home. Ultimately he was admitted to a skilled nursing facility for rehabilitation. So after a trip to the ER, a few days in the hospital ward, even more in a rehabilitation center, Walter finally made it back home ten days later. Ten days, and with several thousand dollars worth of hospital bills.

While your name may not be Walter, chances are one part of this story would be true for a lot of us. We feel that there’s something seriously wrong with our health, we call 911 and go to the ER. The ER is a place where patients have immediate access to life-saving care. From the moment 911 picks up your call, an elaborate system of care is set into motion. This hospital-based system uses robust emergency medical services to help patients that might be seriously injured or critically ill.

There are trained physicians, certified emergency nurses, critical care technicians, access to trauma surgeons, and other specialty physicians. It’s where you go when your throat closes from an allergic reaction and you can’t breathe, or when you fear that there may be internal bleeding from a bad accident, or a head injury. The ER offers expert care when it comes to these emergency situations.

Let’s face it: the ER saves lives. There’s a good chance that somebody sitting in this room has been a patient of mine in the ER, and if not me, someone just like me – someone who took care of you in one of your most vulnerable times; someone who was able to tell if your belly pain was appendicitis or if it was just Aunt Judy’s bad lasagna, or your heartburn and chest pain was related to reflux, or if it was actually a blocked artery in your heart; somebody who took care of you regardless of your circumstances; someone that’s caring for patients in one of more than 5,000 emergency departments throughout the United States.

Now the ER is set up for acute, unscheduled medical emergencies, like heart attacks, strokes, major traumas, or when you decide that getting drunk and breaking into an ostrich farm to “dance” with a 300-pound ostrich sounds like a good idea until he stomps on you, and you wake up in the hospital with your rib cage collapsed and just the vaguest recollection of the biggest chicken that you ever saw. True story.

But over my last 20 years working days and evenings, overnights, holidays, caring for patients with minor ailments to severe life-threatening conditions, I’ve seen the ER become a place of convenience for expedited care for those that have medical emergencies but not necessarily threats to life or limb. Today, approximately 37% of all ER visits are considered potentially unnecessary, and fewer than one in ten ER patients has an injury or condition that’s severe enough to have to stay in the hospital.

Because the ER has to be fully prepared with specialists, training, medications, and equipment for the worst case scenarios, ER care can be some of the most expensive care out there. We’re talking nearly 46 million visits with a cost of four to six billion dollars for care that could potentially be done in another setting. And the cost for individuals is high as well.

In Colorado, the average ER plus ambulance cost is approximately $3,200, and nationwide, that range is between $1,400 and $3,600. And there are considerations besides cost. For elderly patients like Walter that go to a hospital, they can become weak and frail just from staying in the hospital for a few days. And for all of us, there’s a 5-10% chance of getting some type of infection just from staying in the hospital.

Now, most of us can think of a time when we felt too sick or too uncomfortable and felt that we only had a few options: stay at home, try and weather the storm; get dressed, get in the car, head to the hospital; or call an ambulance and go to the ER. But do we really need to go to the ER for nausea, vomiting, and dehydration? For a fever? Even for a big cut on your arm? Does everyone that goes to the ER really need that high of a level of care?

The ER has become this safety net for all that are injured or ill and according to the CDC, 2015, 46% of patients that went to the ER stated they did so because they had no other place to go for care. Unfortunately, this puts a big burden on our medical professionals and we know that patients aren’t getting the best care for their needs. We need to reimagine the ER to provide better, faster, less expensive care that focuses on bringing care into our communities by literally bringing emergency care into our homes.

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