What Is the Role of Emergency Departments in the Future of Exceptional Care?

New philanthropic gift from Ted and Kathy Truscott will help BMC’s emergency medicine department confront operational and societal challenges.

Boston Medical Center’s (BMC) Emergency Department serves as the vital “front door” to the BMC health system, treating an average 400 patients daily and 130,000 annually. Beyond acute care, the ED offers highly specialized wraparound services that have become national models to address social determinants of health. However, like all emergency departments, the BMC ED is not immune to society’s most pressing challenges: staff burnout, the rising incidence of mental health and substance use disorders, and the growing number of individuals in need of necessities, such as food and housing. 

Recognizing the BMC ED’s critical role in meeting the community’s evolving needs and creating sustainable solutions to healthcare, Columbia Threadneedle CEO and BMC trustee Ted Truscott and Kathy Truscott have established the Innovation in Exceptional Care Chair in Emergency Medicine through a $4 million gift to the hospital. Christian Arbelaez, MD, MPH, Chief of Emergency Medicine at BMC, is the inaugural chair. 

HealthCity recently spoke with Arbelaez to discuss how this investment in emergency care will fuel innovation in care and ultimately improve the health of Boston’s communities. 

HealthCity: Now more than ever, emergency departments nationwide face many challenges. Given Boston’s specific needs, what are the most pressing issues to tackle in BMC’s Emergency Department? 

Christian Arbelaez, MD, MPH: Boston Medical Center’s challenges are not unique. Last June, I convened a group of 15 emergency departments across the country at the Leaders of Essential Emergency Departments Conference, and we found we were all confronting the same challenges. The first [shared challenge we discovered] is financial sustainability. Inflation is rising, and our reimbursements are either flat or decreasing, leading to challenges in hiring and maintaining our workforce. 

“As an essential hospital and health system, BMC is a national model that combines excellent clinical care with a strong focus on health equity.”

The second challenge is declining access to primary care and behavioral healthcare. With rising mental health needs and substance use disorders, patients who cannot access those services directly come to the emergency department for treatment instead.  

Lastly, we have a large patient population facing housing insecurity, food insecurity, language barriers, and other social determinants of health challenges. Emergency departments see the manifestation of issues not only in the healthcare system at large but also in the educational, transportation, and urban design systems. 

HC: BMC’s emergency department is recognized as a national model of care. Can you describe some approaches and programs that have earned this reputation? 

CA: As an essential hospital and health system, BMC is a national model that combines excellent clinical care with a strong focus on health equity. We are a Level 1 trauma center and have earned a national reputation through events, like the Boston Marathon bombings and our COVID-19 response. As one of the nation’s busiest emergency departments, we provide clinically excellent care and highly specialized wraparound services that have become national magnet programs, such as the Violence Intervention Advocacy Program (VIAP) and Project ASSERT.  

Post-pandemic, we looked at our processes critically to improve efficiency and implemented the rapid assessment zone (RAZ) model. RAZ is our frontline team’s commitment to streamline care processes from entry to discharge to help reduce patient wait times.  We continue to exemplify operational performance excellence, but we are also looking at our strategy to push the frontier through transformational change. 

HC: Ted and Kathy Truscott’s $4 million gift created the first philanthropically endowed chair position at BMC. What does this endowment mean to you personally and for the future of care at BMC?  

CA: It means a lot to be an endowed chair at this moment. I was born in Colombia. We left when I was 10 because of the conflict in my country. I was the first generation in my family to go to college. I want to serve as a role model to boys and girls with similar experiences. I believe it sends a strong message that I want to share with our community and hospital members.  

As for what it means for the future of care at BMC? To those to whom much is given, much is expected, and I feel an immense responsibility to show how we can deliver and make these dollars stretch to make a significant impact. I am excited about the challenge and the future of care and believe this new endowment will push the frontiers of emergency medicine to spur community impact. 

HC: How will this gift from the Truscotts enable you to innovate and invest in ideas that might not otherwise receive funding?  

CA: The BMC Emergency Department provides such a broad and profound impact on so many people’s lives as they experience care. The Truscotts recognize that the department is critical in helping BMC create thriving communities and a thriving workforce. This is truly a transformative and historic gift. With the challenges we currently face, the Truscotts’ investment helps create a path toward sustainability, allowing us to innovate and show proof of concept for the benefit of our patients.  

“The Truscotts recognize that the department is critical in helping BMC create thriving communities and a thriving workforce. This is truly a transformative and historic gift.”

“The Truscotts recognize that the department is critical in helping BMC create thriving communities and a thriving workforce. This is truly a transformative and historic gift.”

My teams are currently working to envision what emergency care needs to look like in Boston in 10 years so that we can start building it today. We are developing a strategic framework that includes growth, innovation, integration, equity, and performance excellence. As an accountable care organization, we must add value to every one of our patients. New and alternative care models to address capacity constraints and the root causes of the social determinants of health will play a significant role. This includes leveraging virtual care and digital technology. For example, we are one of the first safety-net hospitals to launch a program called BMC Hospital at Home, enabling us to provide care to patients and help them heal in the comfort of their homes. Continuing to move the needle on health equity, we want to take our THRIVE screening program to the next level to better connect people to food, insurance, and housing. We will also continue to innovate to be a central support for BMC’s Center of Excellence in Sickle Cell Disease. 

Our dedication to community engagement and health equity is at the heart of this. Our vision is to transform our communities and their health, and this endowed chair will allow us to maximize that impact. 

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This interview has been edited and condensed for clarity and length.