The Waiting Room:

Analyzing Efficiency Problems

in Pediatric and Adult
Emergency Medicine
Jessica Jiang, Ana Shimeall, Andrew Tsai

Ana Shimeall
Senior at Centennial High
School
Mentor: Dr. Mallemat/Sean
Naron
Internship: UMMC ED &
Baltimore City Health
Department

Jessica Jiang
Centennial High School senior
Mentor: Dr. Sam Hsu
Internship: Mercy Medical
Center
Baltimore, MD

Andrew Tsai
Internship: Howard County General Hospital
Mentor: Dr. Meng Choo, Pediatric Emergency
School: Centennial High School, Senior

Introduction
Ana- Reducing Emergency Room Overuse: The
Problem, Methods, and Target Population
Jessica- Combating the Frequency of Substance
Abuse Related ER Cases: Specialized Treatment
Procedures
Andrew- Psychotherapy: Do We Have Enough
People Invested?

Reducing Emergency Room

Overuse
Implementing case management
Deferring patients with nonurgent concerns screening, cost sharing programs
Expanding access to primary care & creating
health care homes

Case Management
Individualized rehabilitation program for patients
who use emergency services frequently for urgent
reasons

Identification

Assessment

Planning

Implementation

Evaluation &
Monitoring

Screening and Cost Sharing

Programs
Screening: deferring nonurgent patients after they
arrive

significant trauma, fever of 103+, reduced mental alertness,

overdose, respiratory stress, substernal pain, labor, shock, bleeding

Cost Sharing: fee to prevent further nonurgent use

Must refer to accessible primary care provider & schedule
appointment

Alternative Care: Primary Care

& Health Homes
Redistributing patients overcrowding the
ER

Primary Care:
Refer patients suffering from chronic
conditions to primary care
physicians
Prevents the need for future ER use

Health Care Homes:

For areas with high frequent user
concentrations
Offer more specific & less expensive
care

Combating the Frequency of Substance

Abuse Related ER Cases

Research: Methods of
Reduction
Individualized Care Plans

Specialized Addiction Care

Procedures

SBIRT

Individualized Care Plans

Super-frequent users
10+ visits annually

Development of CREDO
Developed to effectively manage these
frequenters

Results
33 annual visits to 11.6

Specialized Addiction Care

Procedures

Results
Combination
treatment: 75+%
in a treatment
program

Referral only:
37%

Counseling and
referral: 45%

SBIRT
Screening
Brief Intervention
Referral
Treatment

Psychotherapy: Overview of
Why We Need It
Increasing problem in society, especially for youth
Depression and anxiety lead
Suicide #3 for death
people to experience depression
64% doctors say improvement needed
From experience at my internship
Almost always psych patients in the ER
Many for 70+ hours, several for 100+
Ped ER is widespread, busy
Often transferred

Goal
Decrease excessive ER
time
Unspecialized

Increase psychotherapists
Specialized

Treatment: What Needs To Be

Improved
Pharmacother
apy

Psychotherapy

SSRIs side effects

50% 6-17 yo w/ psychotherapy 2007, 41% in
2007
Population Increase
Non-metropolitan areas...less likely exposed
to a psychosocial treatment (Finnerty)
62% mental health patients untreated
22% Combo, 13% Counseling, 3% Pure
Med
71% say fluoxetine + CBT is effective
36-69% for SSRIs (multiple ranges)

How To Improve Psychiatric

Treatment
62% untreated: Increase awareness and be
proactive with symptoms
Foster community support
Clinics, drives, outreach to help lower income

Psychotherapists
Counter population growth
Respond to community problems