Medicine at the speed of life

When Gail D’Onofrio, M.D., finally makes it home after a 10-hour shift, her three children always ask the same question: “Did you save anyone’s life today?”

The deep satisfaction of helping patients through medical crises—and sometimes saving lives—first drew her to emergency medicine, says D’Onofrio, who was recently appointed as both chief of adult emergency services for Yale-New Haven Hospital and chief of the section of emergency medicine at the School of Medicine.

Her two jobs carry a long list of duties. In addition to managing the Emergency Department (ED) at YNHH and at the Yale-New Haven Shoreline Medical Center in Guilford, Conn., D’Onofrio is an associate professor in the medical school’s Department of Surgery, conducting research, teaching medical students and training emergency physicians in residency.

But D’Onofrio says she would gain the deepest satisfaction if more people were able to avoid visits to the ED altogether; to that end, her efforts are devoted as much to changing lives as saving them.

As medical director of New Haven’s Women’s Heart Advantage program, D’Onofrio teaches patients and clinicians about the risks of cardiovascular disease in women.

Because half of the major trauma injuries seen by ED physicians are related to drugs or alcohol, she also heads Project assert, a program in which peer counselors conduct brief interviews of emergency patients to determine whether they abuse alcohol or drugs and to suggest options for treatment if necessary. While similar programs elsewhere target injured patients, such as those involved in car crashes or falls, Yale screens all patients well enough to be interviewed, even those with minor illnesses such as sore throats.

Like any other unmanaged chronic illness, addiction will likely land patients in the ED again and again. But thanks to partnerships that assert has formed with community agencies, D’Onofrio can point to former repeat patients who no longer show up in the ED because they are succeeding in substance-abuse treatment.

According to the American College of Emergency Physicians, 70 percent of Americans believe emergency departments are approaching a crisis because of overcrowding, and D’Onofrio does not disagree. She thinks of her department as “a canary in a coal mine” that lays bare every deficiency of the larger health-care system, particularly unequal access to care, which places particular stress on her EDs. But she believes that emergency physicians can take positive steps to improve their own departments.

“We need better ways to be efficient,” D’Onofrio says, citing as an example a new center within her department where patients who have chest pain can get stress tests and blood work done very rapidly—evaluating such patients may now take from nine to 20 hours, as opposed to several days if they were admitted to the hospital. She believes that using similar evidence-based protocols for other common ED complaints will reduce unnecessary admissions and move patients through her department more quickly.

Increasingly, D’Onofrio is putting her energy into planning and adjusting systems to ease the overcrowding that plagues ED patients and clinicians alike nationally. But she remains passionate about the fast-paced environment that first attracted her to emergency medicine, a realm where bringing all one’s clinical knowledge and skill to bear in an instant can—as her children remind her—save a life.