Bill Gardner has a nice post on the use of Emergency Rooms (ER) for non-emergent care. Such use clogs the ER and is an expensive way to deliver basic care. However, many poor persons have no viable alternative. This is an old problem, and providing everyone with health insurance will not fix it. We need a care delivery innovation of some sort.

I have been considering investing in a food truck in Durham; the many food truck options in and around Durham, NC make me think that I have already missed the investment wave. However, my analysis has lead me to wonder if the food truck concept could be a useful way to address the use of ERs for non emergent care.

The best food trucks I have visited provide good quality food at a relatively low cost, typically by consistently providing a narrow range of fare, and showing up where the customers are when they want to eat.

In the same way, if Duke University Health System had an “ER on wheels” (or several) they could provide basic care at a lower cost than they do at the Duke ER, and could go to where the patients were. In fact, one set up just outside of the entrance to the ER might be the first place to start. After that, you could imagine a twitter-driven service in which The Duke ER trucks broadcast their locations; potential patients could tweet or facebook them and say “can you come near the intersection of X and Y street, I think my 10 month old may have an ear infection and I need to figure out if I have to call out sick from work tomorrow”. Patterns of use would emerge. Even if you assumed everyone using such an ER truck was uninsured (they wouldn’t be if competent care could be delivered quicker and cheaper than that at the ER), then it would be advantageous to Duke to undertake something like this so long as the cost was less than their cost of providing care to the uninsured in the ER.* And what patient wouldn’t want to avoid an hours-long wait in the ER?

You can definitely deliver health care via a truck or bus as Hangoverhaven is demonstrating in Las Vegas.

Our facility is open seven days a week from 8 am to 4pm. We have a shuttle that can come pick you up and drop you back off. We have a special WSOP package that is one bag of IV fluids, IV vitamins, and IV glutathione. Glutathione is an antioxidant that also supports mental function. I have been using it the last few weeks with clients and have noticed a significant difference. The WSOP package is priced at $99.

Now, no matter what you think of this service (they take reservations!), it is a case of taking the care to where the people are (Vegas Strip) and addressing their felt needs (they really feel them). And Dr. Jason Burke, the doc/entrepeneur who started this business is a Board Certified Anesthesiologist who trained at Duke. Maybe we need to get him back here for a consult, and see if a mobile ER might not provide quality care while both reducing costs and improving patient satisfaction.

I am being totally serious. When you see the same problem over and over (use of the ER for non emergent care), you need an innovation of some sort.

*I had a surprisingly hard time finding the value of uncompensated care that Duke University Health System says it provides via its Emergency Room, meaning I can’t find I number whose source I understand; I will update when I can dig it up.

[Cross-posted at The Reality-based Community]

Don Taylor

Don Taylor is an associate professor of public policy at Duke University, where his teaching and research focuses on health policy.