Exploring the World of Emergency Critical Care
Dr. Jenny Wilson, director of the Stanford Emergency Medicine Division of Critical Care, offers unique insight, predictions, and concerns for the specialty in a recent interview.
What ECC innovations or research areas most excite you, especially for improving time-sensitive conditions like stroke or trauma?
Emergency Critical Care physicians practice in diverse settings, including emergency departments, hybrid ED-ICU programs, and many different ICUs. Similarly, ECC researchers have a broad scope of interest.
A unifying theme for many in our field is a special interest in and passion for the early identification and management of patients with critical illness. Whether that’s studying the biology of different critical illness syndromes, developing electronic phenotyping capabilities, or working on healthcare systems to improve access to critical care services, we all understand the importance of prompt recognition and early interventions for our vulnerable patients.
In this way, we very much fit into the broader and very dynamic project of precision medicine: we care for the sickest of the sick, but our focus remains on getting the right care to the right patients at the right time and in the right place.
How has ECC evolved in your time as a clinician?
When I first graduated from fellowship and passed my boards, there were very few ECC mentors available to help me find a path forward in my career. Luckily, many forward-thinking mentors from anesthesia and medicine backgrounds stepped up to help me along the way.
This interdisciplinary cooperation and mentorship has been critical to the success of our field and is still in many places. But I’m happy to say that a decade later, we have a growing number of ECC leaders who have succeeded in both academic and community practice and are out there investing in the future of ECC through training and mentorship of the next generation.
As the number of ECC doctors has grown, so have the opportunities available to us. We are no longer having to explain our training pathway or take jobs as “fill-ins” for intensivists from other training backgrounds. EM-trained intensivists are more accepted and visible within the critical care community, and there is a greater understanding of the special skills and value we bring to the field.
How do you see advances in AI playing out for ECC?
As in other fields, I think AI will help ease the documentation burden and speed the pace of discovery for ECC research. And while we are a long way from a robot being able to drop a code line, supervise an airway, or lead a compassionate and impactful family meeting about end-of-life care, I think it is very possible that AI interventions will help us improve our triage processes and resuscitation outcomes within the next 10 years.
What’s the most significant gap in emergency medicine research that urgently needs attention?
As emergency physicians, our biggest job is to quickly evaluate for dangerous illnesses and injuries. This is challenging; many, many patients show up to emergency departments with similar concerns (fever, headache, back pain, etc), but not all of them will go on to require hospitalization or other emergency interventions.
We spend a lot of time and resources working to identify at-risk patients because it is our responsibility not to miss the chance to help, but this process can be inefficient and expensive. New approaches to rapid and efficient evaluation of patients seeking emergency care are needed, both to fulfill our duty as the safety net for the entire healthcare system and to contain healthcare spending and ED/acute care crowding.
Stanford and other academic institutions like it are leading this work, leveraging tools like the EHR, novel biomarkers, and AI to enhance both our efficiency and effectiveness in getting the right care to the right patient at the right time.
What is one misconception about ECC you would love to correct?
EM-trained intensivists leave their training equipped to practice in a variety of settings. While many of us go on to work exclusively in the ICU after completing fellowship, we take our emergency medicine training with us wherever we go. For us, a career in critical care is not a departure from emergency medicine, but rather an expansion of how we define what it means to be an emergency physician.
How can we foster more interdisciplinary collaboration between emergency medicine and other specialties to improve the quality of care in critical situations?
We have a great model for interdisciplinary critical care at Stanford. Our critical care fellowships are the heart of our collaboration, and I believe foundational for improving care of critically ill patients writ large. Continuing to engage in research, clinical care, and education with a multidisciplinary approach is the best way to ensure that patients don’t fall between “silos” and move the field forward as a whole.
How does Stanford ECC hope to influence the field of ECC?
Stanford, along with several other key partner institutions, is defining the field of ECC. Through our research, clinical practice, and involvement in CCM training programs, we are shining a light on the special role ECC can play in the vital work of triage, resuscitation, and transitions of care for critically ill patients. We are proof that EM-trained intensivists are part of the solution to getting patients the right care in the right place at the right time.