Back
in
the
saddle

July 10, 2014 -- For three days, I shadowed an RN in Kaiser's Richmond, CA Emergency Department (ED). Having done my RN preceptorship in another Kaiser ED (South San Francisco), it was good to be back in the saddle.

Emergency Departments serve a variety of unique purposes in our complex healthcare system. Here are a couple of observations about that.

  • The ED is an essential portal to the hospital, admitting more than half of its inpatients. Thus, its diagnostic and triage functions must be finely honed. It serves as a gatekeeper for services that are often hugely expensive. Decisions are made here that are both medically and economically impactful.

  • It is the only place in our healthcare system that is obliged to deliver care without regard to a patient's ability to pay. This is mandated by the Federal 1986 Emergency Medical Treatment & Labor Act (EMTALA) Act. As a result, the ED often serves as the sole provider of primary care for the medically indigent.

These are onerous demands yet at Richmond Kaiser they are skillfully performed day after day. Thank you, Kaiser, for another excellent experience!

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