Seniority of Emergency Physician, Patient Disposition and Outcome Following Disposition

Li, Chao-Jui; Syue, Yuan-Jhen; Kung, Chia-Te; Hung, Shih-Chiang; Lee, Chien-Hung; Wu, Keng‐Liang

doi:10.1016/j.amjms.2016.02.041

Cited by 10 publications

(9 citation statements)

References 27 publications

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“…14 In a multicenter study, Li et al found that the best quality of care (lowest mortality, fewest 72-hour returns) together with a longer ED LOS for adult non-trauma patients, was associated with senior EPs. 15 Our study confirmed the impact of EP seniority on patient management. We found that senior EPs ordered fewer CT scans than intermediate and junior EPs, but the patient LOS was longer than that for patients treated by intermediate and junior EPs.…”

Section: Discussionsupporting

confidence: 80%

“…Previous research findings have shown that EPs diverge considerably in their clinical practice with respect to ordering imaging studies for patients with dizziness/vertigo. 13 – 15 , 25 , 26 Prevedello et al. demonstrated that EPs differ considerably in their use of head CT. 13 Pines et al.…”

Section: Discussionmentioning

confidence: 99%

“… 14 Most senior EPs have been found to have the lowest discharge rates 14 and best quality of care, assessed in terms of mortality and fewer 72-hour returns to the ED. 15 Only a limited number of studies have investigated the connection between physician seniority and the tendency to order head CT for patients with isolated dizziness/vertigo in the ED, where these complaints are encountered daily. Thus, in the present study, we aimed to assess how the seniority of the treating physician is associated with the use of head CT and with ED LOS among patients presenting with isolated dizziness/vertigo in the ED.…”

Section: Introductionmentioning

confidence: 99%

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Influence of physicians’ seniority on head computed tomography use for patients with isolated vertigo/dizziness

et al. 2020

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Objective Vertigo/dizziness is a common reason for emergency department (ED) visits. Emergency physicians (EPs) must distinguish patients with dizziness/vertigo owing to serious central nervous system (CNS) disorders. We aimed to evaluate the association between physician seniority and use of head computed tomography (CT) and ED length of stay (LOS) in patients presenting to the ED with isolated dizziness/vertigo. Methods This retrospective cohort study included adult patients with non-traumatic dizziness/vertigo in the ED. EPs were categorized according to seniority: junior (less than 6 years’ clinical experience), intermediate (7–12 years), and senior (≥12 years). Results Among 2589 patients with isolated dizziness/vertigo, 460 (17.8%) received brain CT; 46 (1.78%) had CNS disorder as a final diagnosis. Junior and intermediate EPs ordered more CT examinations than senior EPs: (odds ratio [OR] = 1.329, 95% confidence interval [CI]: 1.002–1.769 and OR = 1.531, 95% CI: 1.178–2.001, respectively). Patients treated by junior and intermediate EPs had lower patient ED LOS (OR = −0.432, 95% CI: −0.887 to 0.024 and OR = −0.436, 95% CI: −0.862 to −0.011). Conclusions We revealed different judgment strategies among senior, intermediate, and junior EPs. Senior EPs ordered fewer CT examinations for patients with isolated vertigo/dizziness but had longer patient LOS.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of physicians’ seniority on head computed tomography use for patients with isolated vertigo/dizziness

et al. 2020

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“…The EPs vary significantly in their use of head CT. [13] One previous study has demonstrated that EPs vary in their admit/discharge decision making for general ED patients. Most senior EPs have the lowest discharge rates.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of peer pressure on computed tomography use for dizziness/vertigo patients

et al. 2019

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Dizziness/vertigo is a common complaint in the emergency department (ED). We aimed to evaluate the effect of peer pressure on decision making in emergency physicians (EPs) to use computed tomography (CT) for patients with dizziness/vertigo.We conducted a before-and-after retrospective case review of patients who visited the ED with dizziness/vertigo. EPs were categorized into 3 groups according to seniority (in years of experience: >12, 7–12, and <7). The rate of CT use for EPs, patient number, and CT use were e-mailed monthly to update the EP team on the benchmark rate and shape of the behavior.Among the 1657 (preintervention) and 1508 (postintervention) patients with dizziness/vertigo, 320 (19.3%) and 230 (15.3%), respectively, underwent brain CT. A decrease in the rate of CT use was observed in the postintervention group (odds ratio [OR] = 0.743, 95% confidence interval [CI] = 0.615–0.897), especially in junior EPs (years of experience, <7; OR = 0.667, 95% CI: 0.474–0.933) and younger patients (age, <60) (OR = 0.625, 95% CI: 0.453–0.857).The intervention strategy created peer pressure through e-mail reminders and decreased the rate of CT use for patients with isolated dizziness/vertigo, especially in junior EPs and younger patients.

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“…For example, a research team found that senior emergency medicine physicians had the lowest mortality and fewest 72-hour patient returns compared with younger physicians. [ 12 ] Input from senior emergency medicine physicians regarding patient care resulted in more accurate patient dispositions and improved outcomes compared with the plans created by junior physicians. [ 13 , 14 ] Senior emergency medicine physicians also have improved survival rates of their trauma patients.…”

Section: Introductionmentioning

confidence: 99%

Physician characteristics correlate with hospital readmission rates

Skolka

Lehman²,

Khalid

et al. 2020

Medicine

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Hospital readmission rates are used as a metric to measure quality patient care. While several tools predict readmissions based on patient-specific characteristics, this study assesses if physician characteristics correlate with hospital readmission rates. In a 5-year retrospective electronic record review at a single institution, 31 internal medicine attending physicians’ discharges were tracked for a total of 70 physician years, and 15,933 hospital discharges. Each physician's yearly 7-day, 8 to 30-day, and 30-day readmission rates were compared. Each rate was also correlated with years of post-graduate clinical experience, discharge volume, physician sex, and fiscal year. Individual physicians had significantly different 7-day, 8 to 30-day, and 30-day readmission rates from each other. The rates were not related to sex, years after post-graduate training, or fiscal year. However, physician patient volume correlated with 7-day readmission rates. Physicians who discharged ≤100 patients per year had a higher 7-day readmission rate than physicians who discharged >100 patients per year. This correlation with patient volume did not hold for the 8 to 30-day and 30-day readmission rates. Individual physicians differ in their patient readmission rates in 7-day, 8 to 30-day, and 30-day categories. A critical level of a physician's hospital activity, as reflected by the number of patient discharges per year (>100), results in lower 7-day readmission rates. Sex, post-graduate years of clinical experience, and fiscal year did not play a role. The lack of correlation between each physicians’ 7-day and 8 to 30-day readmission rates suggests that different physician factors are involved in these 2 rates.

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Seniority of Emergency Physician, Patient Disposition and Outcome Following Disposition

Cited by 10 publications

References 27 publications

Influence of physicians’ seniority on head computed tomography use for patients with isolated vertigo/dizziness

Influence of physicians’ seniority on head computed tomography use for patients with isolated vertigo/dizziness

Effectiveness of peer pressure on computed tomography use for dizziness/vertigo patients

Physician characteristics correlate with hospital readmission rates

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