Strengthening essential emergency departments: Transforming the safety net

Safety-net emergency departments (EDs) are a critical component of the US health care system, delivering emergency care for patients in need, including vulnerable populations. EDs provide unscheduled acute care for patients 24 hours a day, 7 days a week, regardless of a person's ability to pay. In addition, EDs have transformed beyond their traditional roles of providing emergency services and being the centers for regionalized trauma, cardiac, and stroke care, to also becoming stewards of public health by leading screening and treatment efforts for nonemergent conditions, such as HIV, hepatitis C, mental health, and opioid use disorder. Many safety-net hospitals and their EDs serve essential roles in urban and rural communities, making the impact of recent closures particularly concerning. In response, we convened clinical, operational, and administrative leaders of key safety-net EDs across the United States in order to develop expert consensus related to critical issues facing safety-net EDs. The goals were to help inform policymakers about current challenges and to offer timely recommendations so that together we can mend the safety net as the country works toward the goal of health equity for all.