Doubling EMLRC is important step in addressing emergency provider barriers

Expansion is underway to double the size of Central Florida’s Emergency Medicine Learning and Resource Center (EMLRC), a non-profit organization advancing emergency care through advocacy and education by providing assistance to more than 5,000 emergency providers annually.

Groundbreaking for the new two-story complex being built on South Conway Road in Orlando took place April 30. With a target opening date in November, the 9,400-square-foot complex will replace the current facility shared by the Florida College of Emergency Physicians and the Florida Emergency Medicine Foundation.

“It’s about time,” said Vidor Friedman, MD, managing partner and vice president of governmental affairs of Maitland-based Florida Emergency Physicians (FEP), ACEP Board of Directors member, past president of the Florida College of Emergency Physicians (FCEP), and former director of emergency services for Florida Hospital-Celebration Health. “We’ve been in the current location since 1990, and the facility we purchased had served in another function. The building itself isn’t in very good shape.”

The EMLRC has also housed the offices of the Florida College of Emergency Physicians (FCEP).

“Over the years, the center has required more staff as we’ve increased more and different kinds of programming both for the public and ER providers,” said Friedman. “We needed better and more office space to meet those demands.”

The EMLRC provides continuing medical education (CME) locally for providers who choose not to travel, and the center’s educational offerings have moved from bringing people to Orlando for a meeting or conference at a hotel to more online education.

“The current facility has been an asset to the community of emergency care providers for a long time, but it was built at a time when the education and training was a lot different than it is today,” said FCEP executive director Beth Brunner. “It’s served the community well, but going into the future, we need flexible space for providing simulation education and meetings.”

The new headquarters will provide enough space to accommodate an increasing number of conference meetings, on-site educational courses, and visitations from high school and college groups from around the state.

“This is good news, and will help us raise the level of emergency care in Florida,” said Friedman, referencing “America’s Emergency Care Environment:  A State-by-State Report Card – 2014,” in which the state received an overall C-, ranking 27th overall in the 2014 American College of Emergency Physicians’ comparison report card on America’s emergency care environment.

In 2009, America earned an overall mediocre grade of C- on the Report Card. This year, the country received a near-failing grade of D+.

“The trifecta of per capita physician shortages, insufficient hospital capacity and inadequate health insurance coverage are straining our emergency care system to the breaking point,” said Michael Lozano, MD, president of the Florida College of Emergency Physicians (FCEP). “Florida has few psychiatric care beds, which contributes to long wait times for emergency patients. People are waiting on average more than 5 hours in Florida’s emergency departments. These factors contribute to a situation where many - even those with health insurance - are experiencing issues in accessing appropriate emergency care services.”

Room for Improvement

According to the Report Card, Florida faces severe shortages of emergency physicians and other specialists – neurosurgeons, orthopedists and hand surgeons, for example – needed to care for emergency patients. Full implementation of the Affordable Care Act without a Medicaid expansion in the state is expected to severely limit access to primary care physicians, already in short supply.

In individual categories, Florida’s worst grade was an F in Access to Emergency Care, ranking it 49th in the nation.

Florida received a D+ in Public Health and Injury Prevention, partly because of a lack of safe driving laws that resulted in the nation’s highest rate of pedestrian fatalities and a rate of bicyclist fatalities more than twice the national average.

In the category of Medical Liability Environment, Florida received a mediocre C, due to the paucity of insurers offering liability coverage and a lack of pretrial screening panels.

In the categories of Quality and Patient Safety Environment and Disaster Preparedness, the state earned C+ marks. Of specific mention: Florida’s strengths in the former include a funded state EMS medical director and triage and destination policies for both stroke and heart attack patients. The state, impacted annually by hurricane activity, has implemented various policies and procedures to help first responders cope quickly with a disaster. These include application of a statewide high-tech solution for electronic patient tracking and mandatory disaster drills, and exercises for long-term care facilities and nursing homes. These issues are vitally important considering the state’s soaring senior population.

Special Considerations

“Emergency medicine is very unique,” said Friedman, whose physician-owned practice staffs 10 Emergency Departments in Metro Orlando, managing a total volume of more than 500,000 patients a year. “In most states, about 25 percent of the population is seen in an ER department. In Florida, because of our high number of visitors, one-third is seen in a given year. Also, we have probably the highest percentage of Medicare recipients per capita of any state in the country. That puts an additional strain on not just the ER system, but also the entire healthcare system.”

A recently released Rand Corporation study, “The Evolving Role of Emergency Departments in the United States,” found that while admissions to U.S. hospitals grew more slowly than the nation's overall population from 2003 and 2009, most of that growth was prompted by a 17 percent increase in unscheduled admissions made from emergency departments. That growth more than offset a 10 percent drop in admission from doctors' office and other outpatient settings.

“Some say half of all hospital admissions come from the ER,” said Friedman. “Actually, that number is closer to 75 percent. If you’re not scheduled for surgery or outpatient chemotherapy or something similar, the only way into a hospital is through the emergency department. As Floridians age, they’ll need more access to EDs.

“An important aspect about the center is that part of mission of the FCEP and the center is to educate the public about what emergency medicine is and does. The expanded facility will allow us to do that much better than we can now.”

Collaborative Issues

“Florida needs to become a destination of choice for healthcare professionals,” said Lozano. “We need to promote systems and situations where we attract, train and retain all types of medical providers — especially those who work in our emergency departments. One way to do that would be to improve our medical liability environment. Florida has a national reputation as a physician-unfriendly state when it comes to litigation. We need to promote a medical legal environment where skilled and competent physicians feel that they can act in their patient's best interests, and not be constantly second guessing themselves.”

Lozano was quick to point out the Report Card evaluates conditions under which emergency care is being delivered, not the quality of care provided by hospitals and emergency providers. Five categories comprise 136 measures: access to emergency care (30 percent of the grade), quality and patient safety (20 percent), medical liability environment (20 percent), public health and injury prevention (15 percent) and disaster preparedness (15 percent).

The Florida Department of Health (Bureau of EMS), Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), and the Florida Board of Nursing and the Accreditation Council for Continuing Medical Education (ACCME) have accredited the EMLRC to sponsor continuing medical education for paramedics, EMTs, nurses and physicians.

HCA Focuses on Emergency Department Growth in Metro Orlando

Increased access to emergency care is a driving force behind Hospital Corporation of America (NYSE: HCA) healthcare construction projects taking place in Central Florida.

This summer, the Nashville, Tenn.-based company plans to open a $10 million freestanding emergency department in Hunter’s Creek in south Orlando. The 10,600-square-foot facility will staff four emergency doctors, and provide pediatric and adult services round-the-clock.

“Following the recent expansion at Osceola Regional Medical Center, this facility will provide additional quality health services that are needed in our community,” said Robert Krieger, CEO of Osceola Regional Medical Center, which recently opened a new bed tower.

HCA recently opened its freestanding emergency department in Oviedo and is seeking to expand its Emergency Room at Central Florida Regional Hospital.

SAVE-THE-DATE: On June 27-29, the 6th annual Symposium on Critical Care will take place at the Ed Rosen Shingle Creek Resort in Orlando. Michael Winters, MD, a senior editor of the ACEP-endorsed book, “Emergency Department Resuscitation of the Critically Ill,” is slated to speak, along with Amal Mattu, MD, author of a dozen books pertaining to high-risk topics in emergency medicine, and a frequent national and international speaker. Critical care scenarios will be presented and discussed to challenge and educate participants. For more information about this CME course and an upcoming one in September, visit http://www.floridaep.com/#!symposia/cmxs.