Joel Stettner, MD
Imamu “Mu” Tomlinson, MD
In a conversation with Joel Stettner, MD, former Managing Partner of Vituity and past Cal ACEP President, and current Vituity CEO Imamu “Mu” Tomlinson, MD, MBA, the physician partners reflect on the history of emergency medicine and look forward to what lies ahead.
MT: For young emergency physicians today, it may be hard to believe that not long ago, patients coming into the emergency department took their chances on what type of doctor was going to treat them. What was it like working in the emergency department then?
JS: Back then, all physicians on staff at a hospital, no matter what their specialty, would have to rotate through the emergency department as one of their responsibilities. So, you could have a family practice doctor, a gynecologist, a psychiatrist, or an ophthalmologist working in the emergency department, without any specialized training, seeing cases they might not be particularly familiar with. It was stressful for the doctors, and it wasn’t ideal for the patients.
MT: From the histories I’ve read, it was the partnerships between organizations like Vituity and associations like ACEP that moved emergency medicine from a concept to a reality. It wasn’t an easy specialty to get the medical community behind. You must have had your work cut out for you.
JS: Absolutely. We understood that the key to a successful specialty was to have an organized approach delivered to hospitals in an organized way by an organized group of physicians. Vituity helped ACEP grow by encouraging its partners to become members and provide energy through participation. We wanted to claim our rightful place in the health care system. I think ACEP did a lot of great things for the health and wellbeing of the country.
MT: And so, the emergency medicine specialty was finally recognized in 1979, with its own residency program. We’ve come a long way since then, with a consistent eye on innovation.
JS: What made Vituity successful—and a strong influence on the specialty—was the fact that our values were high, consistent, and adhered to. Consistency proved critical to the recognition of emergency medicine.
Efforts were always made to empower local medical directors, physicians, and advanced practice providers to suggest innovations based on their front-line perspectives. Vituity leadership would listen to their recommendations and pursue the concepts to determine if they were worthwhile. Some of the great innovations in emergency medicine came early on as a result of need. OnCall was developed by Vituity as a way to provide telephone triage service to patients by using registered nurses and physicians to guide patients toward the most appropriate source of care. That model is still used as a standard in the industry.
MT: Another great Vituity innovation was rapid medical evaluation (RME).
JS: Right, our own CMO, Prentice Tom, MD, presented RME at the ACEP Scientific Assembly in 2001.
There was a trend of full waiting rooms in the 1970s and 1980s. People were walking out because they had to wait so long. Dr. Tom saw that the situation could be improved by getting patients seen by providers during triage. This way, evaluation could start even when beds weren’t available. The protocol significantly reduced the time it takes to see patients in the emergency department, from 3.5 hours to 20 minutes!
It took an organization-wide effort to support this new protocol. One of our medical directors at the time, Mike Sequeira, MD, was an early adopter who encouraged every one of his sites to put the process in place. He began talking with emergency departments all over the country. Since then, RME has been adopted as a best practice across the industry.
MT: A mini-revolution!
JS: Definitely impressive. And, while I’ve retired from emergency medicine, I look forward to its future as I know there are more great things to come.
MT: Yes, new models that incorporate technology and subspecialists are continuing to improve patients’ access to critical services. ACEP’s former president-elect, John Rogers, MD, recently mentioned stabilization units, such as Vituity’s EmPath units, as a hopeful development in the treatment of psychiatric patients. Telepsychiatry in the emergency department is also helping patients get the evaluations and treatment they need right away. Likewise, with teleneurology, even rural emergency departments have access to neuroology consults, and we all know that timely intervention saves lives when it comes to stroke.
Emergency medicine really is improving the quality of lives across the country.
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