Thursday, December 12, 2013 EDs Need to Switch From 'Front Door' to 'Front Porch' According to a recent analysis, the pressures of an aging US population should cause emergency departments (EDs) to rethink delivery of care based on cooperative interdisciplinary decision-making, including comprehensive discharge planning involving physical therapists (PTs) when appropriate. The report, "Transforming Emergency Care for Older Adults," (abstract only available free) appears in the December 2013 issue of the health care policy journal Health Affairs and describes how EDs can respond to the "silver tsunami" affecting nearly all areas of health care. The article's authors assert that success will require EDs to seize "opportunities to transform the emergency department's … role as the 'front door' of the hospital to becoming the 'front porch,'" where treatment is provided with attention to what happens after the patient leaves the ED. Among the recommendations included in the analysis are the use of evaluative measures of cognitive function and discharge risk assessments, and the creation of "comprehensive discharge planning that includes shared decision-making." The plan should also include a high level of involvement with care transitions and "appropriate specialty consultation, such as physical therapy or home services, or both," authors write. The article warns that these new models of care for EDs that employ "much needed care-coordination" could, in the short term, increase ED lengths-of-stay and costs. However, authors assert that the changes create an opportunity for "pivotally improving patient health outcomes and facilitating optimal shared decision making while reducing admissions, ED revisits, and overall care costs." Health Affairs recently held a briefing on the latest thoughts on EDs, and has made video and other materials available online for free. PTs can find out more about the integral role of physical therapists in emergency care at APTA's webpage devoted to physical therapy practice in EDs.