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  1. What performance gaps led to the emergence of Emergency Medicine (EM) as an independent specialty?

  2. What training do emergency physicians receive during residency, and what subspecialties are available after training?

  3. In what ways do Emergency Medicine and Hospital Medicine interact with respect to triage, patient flow, performance measures, comanagement, and care transitions?

  4. What is the Emergency Medical Treatment and Active Labor Act (EMTALA), and how does it govern aspects of Emergency Medicine and Hospital Medicine practice?

The American Board of Medical Specialties describes the practice of Emergency Medicine as focusing on the immediate decision making and action necessary to prevent death or any further disability both in the prehospital setting and in the emergency department (ED) by providing immediate recognition, evaluation, care, stabilization, and disposition of a generally diverse population of adult and pediatric patients in response to acute or episodic illness and injury. Emergency Medicine and Hospital Medicine share many common aspects, and, because many of the patients who will be admitted to the hospitalist service will begin their inpatient care from the ED, it is important for both specialties to have an in-depth understanding of each other's domain, scope of practice, areas of expertise, and foundation in order to provide seamless and integrated patent care.

Emergency Medicine, much like Hospital Medicine, is a specialty that has significant overlap with many other specialties in that it is not a system or procedure-specific specialty but one that specializes in situational presentation of disease. Emergency Medicine is the initial management of any disease that may present in an acute or episodic manner, including acute manifestations of chronic diseases. The value of having a specific specialist available to care for patients emergently during the crucial “golden hour” of injury was first envisioned during the Korean War in the 1950s. Although it is difficult to envision a time when EDs were staffed by junior, untrained, rotating physicians, this was the case as recently as the 1960s and '70s and still persists in other countries. Prior to the 1960s and '70s, any manner of specialty would be assigned to “cover” the ED on a rotational basis as part of a physician's obligation to a hospital. In teaching hospitals, this rotation was often relegated to very junior trainees who would then contact more senior trainees depending on their perceived need.

Beginning in the early 1970s, groups of physicians began to leave private practice to devote all of their clinical work to the ED. The first of these groups was based in Alexandria, Virginia, and their plan, known as the Alexandria Plan, was to provide consistent attending-level emergency care 24/7 year-round by physicians whose only practice was Emergency Medicine. Soon after, the first Emergency Medicine training program was established at Cincinnati General Hospital in 1970, with several other residency programs following suit. With the establishment of the American College of Emergency Physicians (ACEP) there was recognition of Emergency Medicine training programs by the American ...

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