The Social Emergency Medicine Section (SEMS) at ACEP was approved!

Thank you for all your support!

Meeting: Tuesday, October 31st at 2pm
at ACEP18

ACEP Section: Social Emergency Medicine

1.     Section objectives

a.     To promote the incorporation of patients’ social context into routine emergency care.

b.     To serve as a central organizing point for emergency providers interested in the interplay of the emergency care system and social forces affecting both patients and communities.

c.     To foster high-quality research and translate this research into best practices for the application of social determinants of health at the bedside and beyond.

d.     To disseminate emergency department (ED) interventions that improve population health through emergency care informed by community needs, with a focus on EDs that see underserved patients.

e.     To propose, evaluate, and critique health policies that affect the social determinants of health of our communities, especially as they pertain to marginalized and vulnerable populations that frequently present to EDs for their care. 

2.     Description of subject area addressed by section

a.     The history of the specialty of Emergency Medicine is uniquely tied to the need for high quality emergency medical care for marginalized and underserved communities and patients.1 Social Emergency Medicine (SEM) works to incorporate social determinants of health and the social context of our patients’ lives into patient care in the ED and beyond. Social Emergency Medicine not only considers the social determinants underlying health and illness, but also aims to develop systematic interventions, measure their effects, collaborate with others, and advocate for national, state and local policies that will improve the health of our patients.

3.     How section will further ACEP’s ability to meet its objectives:

The Social Emergency Medicine Section (SEMS) addresses the following ACEP objectives:

To establish guidelines for quality emergency medical care.

In order to provide quality emergency medical care, it is imperative for physicians to be able to recognize the social determinants of health that lead people to seek emergency care. Trauma due to neighborhood violence and easy access to lethal means, environmental exposures related to homelessness, and repeat visits for asthma exacerbations due to environmental exposures are just a few examples of the many ways in which social determinants of health underlie an acute medical complaint in the ED. Improvements in quality of care in the ED can and should focus on factors that affect our patients’ health before they arrive in extremis.3The SEMS seeks to develop guidelines for quality improvement via the practice of SEM through a comprehensive approach to patient care that is integrated within the broader community and considers the both medical and social needs of our most vulnerable patients.4

To encourage and facilitate the postgraduate training and continuing medical education of emergency physicians.

In order to be effective, Social Emergency Medicine interventions must be constructed from a robust evidence base and will require resources, multidisciplinary collaboration, and specialty training. This Section seeks to promote postgraduate training and continuing medical education opportunities such as fellowships in Social Emergency Medicine. For example,  the goal of the Stanford fellowship is to “train physician researchers and educators dedicated to examining the complex interplay between societal structures, community well-being, and the practice of emergency medicine in order to identify highly impactful points of intervention in the social structures that determine health and disease and in the systems of acute care delivery.”5 There are also a wide range of more general fellowship training opportunities relevant to SEM, such as the National Clinical Scholars Program, a planned fellowship at UCLA in International and Domestic Health Equity and Leadership and others that can be disseminated and promoted by our proposed Section. By training leaders in the Social Emergency Medicine Section, this knowledge can be transmitted to the wider EM practice community through lectures and social media, promulgation of best practices, and continuing medical education.

To promote education in emergency care for all physicians.

The Section will develop and sponsor didactic content at the Scientific Assembly to promote SEM widely among frontline providers. Application of SEM principles should not be confined to academic exercises, but should be integrated into the core daily practice of emergency care. A primary focus of SEM will be the translation of evidence-based, ED-based interventions aimed at improving population health into EDs where they are needed most. There is not a single emergency provider in the country that does not deal with the social context of our patients’ health, yet little provider education is devoted to this area. The SEMS will address this void by focusing its educational activities on how to best integrate social determinants of health into bedside emergency care and population health.

To promote the development and coordination of quality emergency medical services and systems.

Emergency physicians have the opportunity to become leaders in the design and implementation of integrated socio-medical systems of care. Such systems would link the fields of medicine, public health, law and social work and use the emergency medical encounter as a logical site to identify basic social needs and as a gateway to existing community resources.6 This Section seeks to develop ED providers to become co-leaders of multidisciplinary teams designed to close the gaps between ED-based interventions, outpatient care, and social services.

To encourage emergency physicians to assume leadership roles in out-of-hospital care and disaster management.

EMS resources have already been deployed to address social context in many systems (for example, assessment and abatement of asthma triggers, domestic violence referral, and more.) An ACEP SEM section could, for example, promote further research on the integration of community-based EMS – sometimes called “community paramedicine” — in the continuum of care informed by patients’ social context through partnerships with the EMS-Prehospital Care Section and the Trauma and Injury Prevention Section.

To evaluate the social and economic aspects of emergency medical care.

By definition, the proposed SEMS would focus on the evaluation of the social aspects of emergency care. Additionally, one of the major goals of SEM is to improve population health while decreasing system costs and still ensuring that EDs are appropriately recognized and compensated for their unique contribution to health. This Section will provide a forum for interested parties to explore how SEM can exist within, and buttress, an already strained emergency care system.3

To encourage and support basic and clinical research in emergency medicine.

High-quality research will be the linchpin of our understanding of — and our capacity to influence — the social determinants of health through evidence-based interventions. Given the ED’s unique position at the intersection of medicine and community, it serves as a compelling site for clinical and health services research geared towards affecting population health and policy.5 This Section will share resources and best practices,  form research networks for collaborative work and data collection, and disseminate important findings. Our research agenda will emphasize the potential for expanding the role of the ED as a site of public and population health research and interventions, extend the surveillance and data collection capacity of EDs, and increase research on the cost-effectiveness of a diverse array of preventative services implementable from the ED.4

References:

1.     Zink B. Social Justice, Egalitarianism, and the History of Emergency Medicine. Virtual Mentor. 2010 Jun(20).

2.     Anderson ES, Lippert S, Newberry J, Bernstein E, Alter HJ, Wang NE. Addressing Social Determinants of Health from the Emergency Departments through Social Emergency Medicine. West J Emerg Med 2016 Jul;17(4):487-489.

3.     Dworkis, DA, Peak DA, Ahn J, Joseph TA, Bernstein E, Nadel ES. West J Emerg Med 2016 Jul;17(4):484-6.

4.     Anderson ES, Hsieh D, Alter HJ. Social Emergency Medicine: Embracing the dual role of the emergency department in acute care and population health. Ann Emerg Med 2016 Jul;68(1):21-5.

5.     “Social Emergency Medicine and Population Health.” Stanford Department of Emergency Medicine,http://emed.stanford.edu/fellowships/mph.html. Accessed 12 October 2016.

6.     Gordon, JA. The hospital emergency department as a social welfare institution. Ann Emerg Med 1999 Mar;33(3):321-5.