Enhancing the medical practice: consorting with the emergency department

In 1994, the Department of Emergency Medicine at Loma Linda University Medical Center (LLUMC) set out to implement a comprehensive emergency department (ED) model: a model that headed in the opposite direction of popularized solutions of which the objective is to keep patients out of the ED. This model increases the number of services offered. It triages patients within its walls to an area cost effective for the patient's acuity and allows patients to immediately move to a higher level of care if the provider sees the need. Three years of data have determined the comprehensive ED model to be an effective, patient-focused alternative to the "demand management" methods. Low-acuity patients at LLUMC are treated in less costly areas. The high-tech-laden "MainED" is better utilized because of a 25% increase in complex patients since 1993. In addition, the comprehensive ED model appears to be a valuable resource that enhances the outpatient medical practice.