Gianluca Cerri MD, an emergency physician with over two decades of experience, is advocating for fundamental changes in how emergency medicine is structured and led, arguing that systemic weaknesses rather than individual failures are compromising patient care and clinician well-being. His call comes amid significant pressures on emergency departments, which handle more than 130 million visits annually in the U.S., and a concerning trend of rural hospital closures, with over 180 such facilities shutting down since 2005.
Cerri challenges the common perception of emergency medicine as purely reactive. "People think emergency medicine is about reacting fast," he said. "It's actually about preparing well. When systems are clear, teams perform better, and patients are safer." His advocacy centers on practical leadership focused on structure, accountability, and calm execution. Drawing from his roles as a former Chief Resident, rural emergency physician, and clinical educator, he contends that many care failures are system-based. "I've seen excellent clinicians struggle because the process around them was broken," he noted. "When communication fails or roles are unclear, pressure multiplies fast."
This perspective is supported by research. A 2022 study published in BMJ Quality & Safety found that communication breakdowns and system inefficiencies contribute to nearly 30% of serious medical errors in hospital settings, with emergency departments being particularly vulnerable due to their pace and unpredictability.
A critical area of focus for Cerri is the need for early intervention, especially for patients facing addiction-related crises. With more than 80,000 opioid-related deaths reported in the U.S. in 2023, he stresses the importance of initiating meaningful care at the first point of contact. "If someone survives an overdose and walks out without a plan, we missed the moment that mattered most," Cerri stated. "That first conversation can change the entire path forward." Evidence supports this approach; studies indicate patients who begin evidence-based treatment immediately after an overdose are twice as likely to remain engaged in care compared to those receiving referrals alone.
Beyond clinical care, Cerri emphasizes the importance of mentoring the next generation of physicians, teaching that leadership under pressure is as crucial as technical skill. "I tell residents that patients remember how you show up," he said. "They notice if you're calm, honest, and focused. That builds trust faster than any explanation." This focus on leadership is also seen as a potential buffer against physician burnout. According to the American Medical Association, nearly 63% of physicians reported burnout symptoms in recent years, with emergency medicine ranking among the highest specialties affected. "Strong systems don't just protect patients," Cerri added. "They protect clinicians, too."
Cerri outlines actionable steps for various stakeholders. Healthcare professionals are urged to focus on clear communication and team support. Hospital leaders should review and streamline workflows to reduce care delays. Communities can learn about addiction as a medical condition and support early, evidence-based treatment. Patients and families are encouraged to ask questions and advocate for clear care plans before leaving the emergency department. "Leadership isn't a title," Cerri concluded. "It's a habit. Anyone can practise it by staying calm, prepared, and accountable."
