Protecting Patients and Clinicians: Policy Lessons from the Emergency Department

After a 10-hour shift, the heaviness of my hazmat suit stayed with me, dragging my steps through my front door. I had been wearing a battery-powered respirator, head cover and full-body protection for most of the day, not out of preference, but because the climate around emergency care left me no other choice.

That night, I scrubbed my face with rubbing alcohol, replaying every patient interaction and inevitably thinking, “Could I have brought an invisible pathogen home?”

That was our reality during the COVID-19 pandemic. A healthcare system with brittle seams, hanging on half-built policies and solutions yet required to operate at full capacity.

Early in my career, I knew I couldn’t accept the persistence of carelessly curated policies as both patients and clinicians were put at risk. Part of what ignited my interest in this realm was my research on the stroke belt in my home state of North Carolina. This region had significantly higher rates of stroke incidence and mortality compared to the national average.

I thought, “These are my people who are being impacted adversely by stroke.”

The research I did with my mentor gave me a broader perspective on how I can help large communities through research, which can be translated into policies and guidelines for a larger population.

Frustrated by what I witnessed happening across healthcare, I decided to take on leadership roles to advocate for better resources and regulations. I joined the board of the American College of Emergency Physicians in 2017, then became its president in 2023. I was also director of the Health Policy Fellowship Program at George Washington University, where we took physicians’ voices to Capitol Hill to work in congressional offices and play a vital part in important policymaking. Both roles have allowed me to translate bedside realities into actionable policy and national advocacy.

Shaped by Crisis

The COVID-19 pandemic taught us, painfully, that we must be ready for any spontaneous crisis and not let our guard down. Preparedness is an ongoing investment strategy that requires supply abundance, workforce resilience and a flexible infrastructure.

The scarcity of operational resources such as negative-pressure and isolation rooms, personal protective equipment (PPE) and rapid testing forces clinicians to improvise. While thinking quickly on your feet can save lives, many physicians can be restricted from properly treating a patient due to safety risks. These moments can create mortal injury, which leads to burnout and affects the workforce.

The consequences of poor policies are not theoretical; they directly impact how patients receive care and how clinicians deliver it. A few examples include:

• Limited availability of affordable insurance. Patients will often delay seeking care until their conditions become emergencies, which can overwhelm an ED and lead to worse outcomes. Reimbursement models don’t often take into account underserved communities where hospitals have fewer resources, leading to longer wait times, limited service and gaps in follow-up care.
• The high costs of PPE, especially in the climax of the pandemic, forced frontline teams to reuse masks or improvise, which left them severely exposed to dangerous contagions that followed them home.
• Access to care for rural communities means traveling long distances for even basic care. These hours or even days of travel often turn manageable cases into emergencies. The absence of local specialists makes it harder for patients to receive a diagnosis and treatment plans.

In recent days, the adoption of innovative solutions like tele-health is becoming the new norm to combat these issues. Pairing them with strong policies and regulations can become a gamechanger.

A big win for the ED specifically is the Carecube, which is unique for its portability and uses a simple yet very effective concept to reduce the need for patients to relocate. It also protects staff, enabling them to safely deliver care.

From Advocating for One Patient to Advocating for Many

Yet technology alone is not the answer. To truly bridge the gap between policy and bedside care requires intentional advocacy and direct engagement of decision-makers at both the local and national levels. Clinicians hold valuable insights into the realities of patient care, and sharing these needs is critical for creating safer, more effective healthcare policies.

Here’s what we can do as physicians:

• Engage with local leaders
  Participate in hospital committees, advisory boards and community health initiatives to ensure frontline perspectives are getting a seat at the table.
• Communicate with national policymakers
  Provide testimony, submit comments on proposed regulations and collaborate with professional associations to influence legislation.
• Highlight real-world challenges
  Use data, case studies, research and personal experiences to demonstrate the impact of poor policy decisions on patient flow and safety.
• Foster ongoing dialogue
  Build relationships with decision-makers to ensure our voices are consistently considered in policy development.

By taking these steps, we can shape healthcare policies that are both realistic and patient-centered, ultimately elevating the quality and safety of care across the system.

I’ve stood at the bedside through waves of crisis, and I’ve sat in rooms where all hope has seemed lost, but while it can be easy to feel down, it’s important to realize that we don’t have to accept half-solutions.

We can’t wait for perfect solutions or moments to appear. Let’s take the proactive route to build new solutions with intention and consistency. The work is challenging, but the stakes are too high to settle for anything less than healthcare policies that truly reflect the realities of the bedside.

Rural communities, underserved populations and overlooked yet integral clinicians within the workforce are counting on us.