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Preventive care poses dilemma for emergency departments, Stanford study finds
Date:9/26/2010

ol and Prevention released guidelines in 2006 recommending HIV tests be done at EDs.

There is some incentive for EDs to offer preventive services. "Basically, it's about how 'an ounce of prevention is worth a pound of cure,' and we try to do all we can for patients," said Robert Norris, MD, chief of emergency medicine at Stanford Hospital, who was not involved in the study. "One thing that is notable about emergency medicine is that we are often presented with teachable moments. So, for example, people who come in with an alcohol-related injury - we can discuss with them why this happened and how much worse the consequences could have been, and then help to get them set up in a treatment program."

Stanford Hospital's ED is ahead of the curve, providing about a half-dozen innovative preventive services, including:

  • The award-winning nurse callback program, which helps discharged patients to coordinate follow-up appointments and get access to primary or specialty care.
  • A public insurance enrollment program (run in collaboration with San Mateo County) that has enabled thousands of children to get insurance since it began in 2004.
  • "Farewell to Falls," a free, home-based fall-prevention program for older adults that was recognized in 2007 by the Home Safety Council and National Council on aging.

In addition, doctors and nurses in the ED screen patients for domestic violence and alcohol abuse and offer intervention services through ED social workers.

But echoing a major finding of the study, Norris said that cost is a key factor determining which and how many preventive services can be offered at Stanford's ED. "When you're in a resource-constrained environment, you have to pick and choose," he said.

For example, Delgado cited two key factors that discourage EDs from offering HIV tests: One, they add to unreimbursed costs, and two, studies have shown that, if mandated, they can result in long
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Contact: John Sanford
jsanford@stanfordmed.org
650-723-3900
Stanford University Medical Center
Source:Eurekalert

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