STATUS OF CLINICAL AND ACADEMIC EMERGENCY-MEDICINE AT 111 VETERANS AFFAIRS MEDICAL-CENTERS

Study objectives: To assess the current state of clinical and academic emergency medicine at Veterans Affairs medical centers in the nation's largest health care system. Design and interventions: Written survey mailed to 111 Veterans Affairs medical centers. Setting: One hundred eleven Veterans Affairs medical centers affiliated with medical schools and designated as providing acute medical care. Participants: Veterans Affairs physicians and administrative managers responsible for Veterans Affairs medical center emergency departments. Measurements and main results: All 111 Veterans Affairs medical centers surveyed were included in the results. All provide emergency patient care; all but one of these Veterans Affairs EDs (99%) are open 24 hours a day, seven days a week. The mean ED census is 55 patients per day (or slightly more than 20,000 patients annually). The mean percentage of admitted patients is 26%, 31% of whom are admitted to ICUs. Acute, unscheduled ambulance patients are transported from home to 106 (96%) Veterans Affairs medical centers, and 105 (95%) accept patient transfers directly from other hospitals' EDs. House staff rotate through 60 (55%) of these EDs as part of their training; emergency medicine house staff rotate through four (7%) of these EDs. There are emergency medicine residency-trained and/or emergency medicine board-certified physicians in 21 (19%) of these Veterans Affairs EDs. At the time of the survey, 29 (26%) of the respondents were either actively recruiting (12) or planning to recruit (17) emergency medicine staff physicians, including 13 seeking an ED director In five cases, an independent emergency medicine service/section is responsible for their ED, three of which are affiliated with a division/department of emergency medicine at their medical school. Conclusion: In many EDs at Veterans Affairs medical centers, nonemergency medicine staff physicians and house staff unsupervised by emergency physicians care for patients seeking emergency medical care. In addition, there is a growing need for more emergency medicine staff physicians and emergency medicine house staff in the Veterans Affairs system. Organized emergency medicine should initiate efforts to inform administrators and legislators responsible for Veterans Affairs policy making and funding.