The Impact of Emergency Physician Seniority on Clinical Efficiency, Emergency Department Resource Use, Patient Outcomes, and Disposition Accuracy

Li, Chao-Jui; Syue, Yuan-Jhen; Tsai, Tsung‐Ting; Wu, Keng‐Liang; Lee, Chien-Hung; Lin, Yan Ren

doi:10.1097/md.0000000000002706

Cited by 31 publications

(26 citation statements)

References 17 publications

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“…reported that the decrease in readmission was only related to the use of consultants, which is consistent with other studies of the positive effect on ED quality outcomes when comparing experienced doctors to trainee doctors 39,40 . Given the fact that our study compares two models of ED senior sta ng, this could explain the difference in results.…”

Section: Discussionsupporting

confidence: 89%

The effect of the employment of consultants in the Emergency Department on quality of care and equity – a quasi-experimental retrospective cohort study

Lindstroem¹,

Andersen²,

Kallemose³

et al. 2019

Preprint

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Background Crowding and bed occupancy are challenging issues in the hospitals with increasing acute admissions, caused by an aging population. Crowding in Emergency Departments (EDs) has a negative impact on length of hospitalisation, in-hospital mortality, patient safety, and flow. Thus, the Danish Health Authorities recommend the presence of specialist doctors in the ED who are dedicated to execute the clinical decision-making process. Thus, in 2016, the model of acute care was changed in the ED at Hvidovre Hospital, Denmark, to include consultant-led triage and continuous presence of consultants, referred to as Acute Medical Consultants. However, there is little evidence concerning the effect of consultants treating patients in the ED, and how it affects care for patients of varying socioeconomic status compared with other models of ED staffing. This study investigated whether the employment of Acute Medical Consultants in a Danish ED affected the quality of care for acutely admitted medical patients in terms of length of stay, readmission, mortality, and secondly how this effect was distributed across socioeconomic status in patients. Methods Admission data for 9,869 adult medical patients admitted for up to 48 hours in the ED was collected in two separate 7-month periods, one prior to and one after the organisational intervention. Linear regression and Cox proportional hazards regression analyses adjusted for age, sex, comorbidities, level of education, and employment status were applied. Results Following the employment of Acute Medical Consultants, an overall 11% increase in index-admissions was observed, and 90% of patients were discharged by an Acute Medical Consultant with a reduced mean length of stay by 1.4 hours (95% CI: 1.0 – 1.9). No significant change was found in in-hospital mortality, readmission, or mortality within 90 days after discharge. No difference was found in quality of care across socioeconomic status. Conclusion The employment of Acute Medical Consultants in the ED was associated with reduced length of admission without a negative effect on the quality of care for ED-admitted medical patients in general, or for patients with lower socioeconomic status. Yet, in order to reduce readmission and mortality among acutely admitted patients, other means must be initiated.

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Section: Discussionsupporting

confidence: 89%

The effect of the employment of consultants in the Emergency Department on quality of care and equity – a quasi-experimental retrospective cohort study

Lindstroem¹,

Andersen²,

Kallemose³

et al. 2019

Preprint

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“…Third, senior physicians should audit the orders of CT scans by junior physicians in the ED. 17 27 28 …”

Section: Discussionmentioning

confidence: 99%

Trends of CT utilisation in an emergency department in Taiwan: a 5-year retrospective study

Hsieh

Lin

et al. 2016

BMJ Open

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ObjectivesTo investigate the association between the trends of CT utilisation in an emergency department (ED) and changes in clinical imaging practice and patients' disposition.SettingA hospital-based retrospective observational study of a public 1520-bed referral medical centre in Taiwan.ParticipantsAdult ED visits (aged ≥18 years) during 2009–2013, with or without receiving CT, were enrolled as the study participants.Main outcome measuresFor all enrolled ED visits, we retrospectively analysed: (1) demographic characteristics, (2) triage categories, (3) whether CT was performed and the type of CT scan, (4) further ED disposition, (5) ED cost and (6) ED length of stay.ResultsIn all, 269 239 adult ED visits (148 613 male patients and 120 626 female patients) were collected during the 5-year study period, comprising 38 609 CT scans. CT utilisation increased from 11.10% in 2009 to 17.70% in 2013 (trend test, p<0.001). Four in 5 types of CT scan (head, chest, abdomen and miscellaneous) were increasingly utilised during the study period. Also, CT was increasingly ordered annually in all age groups. Although ED CT utilisation rates increased markedly, the annual ED visits did not actually increase. Moreover, the subsequent admission rate, after receiving ED CT, declined (59.9% in 2009 to 48.2% in 2013).ConclusionsED CT utilisation rates increased significantly during 2009–2013. Emergency physicians may be using CT for non-emergent studies in the ED. Further investigation is needed to determine whether increasing CT utilisation is efficient and cost-effective.

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“…Compared with the itemized rating section, providing written feedback is usually more time-consuming. Li et al ( 2016 ) evaluated EP efficiency in the Taiwanese healthcare system. They found that senior EPs take longer than junior EPs when ordering prescriptions and patient disposition in treating both urgent and non-urgent patients (Li et al 2016 ).…”

Section: Discussionmentioning

confidence: 99%

“…Li et al ( 2016 ) evaluated EP efficiency in the Taiwanese healthcare system. They found that senior EPs take longer than junior EPs when ordering prescriptions and patient disposition in treating both urgent and non-urgent patients (Li et al 2016 ). It is likely that some of the written feedback components were possibly omitted for these reasons in our busy ED.…”

Section: Discussionmentioning

confidence: 99%

Exploring the influence of gender, seniority and specialty on paper and computer-based feedback provision during mini-CEX assessments in a busy emergency department

Chang

Lee

Chen

et al. 2016

Adv in Health Sci Educ

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The mini-clinical evaluation exercise (mini-CEX) is a well-established method of assessing trainees’ clinical competence in the workplace. In order to improve the quality of clinical learning, factors that influence the provision of feedback are worthy of further investigation. A retrospective data analysis of documented feedback provided by assessors using the mini-CEX in a busy emergency department (ED) was conducted. The assessors comprised emergency physicians (EPs) and trauma surgeons. The trainees were all postgraduate year one (PGY1) residents. The completion rate and word count for each of three feedback components (positive feedback, suggestions for development, and an agreed action plan) were recorded. Other variables included observation time, feedback time, the format used (paper versus computer-based), the seniority of the assessor, the gender of the assessor and the specialty of the assessor. The components of feedback provided by the assessors and the influence of these contextual and demographic factors were also analyzed. During a 26-month study period, 1101 mini-CEX assessments (from 273 PGY1 residents and 67 assessors) were collected. The overall completion rate for the feedback components was 85.3 % (positive feedback), 54.8 % (suggestions for development), and 29.5 % (agreed action plan). In only 22.9 % of the total mini-CEX assessments were all three aspects of feedback completed, and 7.4 % contained no feedback. In the univariate analysis, the mini-CEX format, the seniority of the assessor and the specialty of the assessor were identified as influencing the completion of all three components of feedback. In the multivariate analysis, only the mini-CEX format and the seniority of the assessor were statistically significant. In a subgroup analysis, the feedback-facilitating effect of the computer-based format was uneven across junior and senior EPs. In addition, feedback provision showed a primacy effect: assessors tended to provide only the first or second feedback components in a busy ED setting. In summary, the authors explored the influence of gender, seniority and specialty on paper and computer-based feedback provision during mini-CEX assessments for PGY1 residency training in a busy ED. It was shown that junior assessors were more likely to provide all three aspects of written feedback in the mini-CEX than were senior assessors. The computer-based format facilitated the completion of feedback among EPs.

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The Impact of Emergency Physician Seniority on Clinical Efficiency, Emergency Department Resource Use, Patient Outcomes, and Disposition Accuracy

Cited by 31 publications

References 17 publications

The effect of the employment of consultants in the Emergency Department on quality of care and equity – a quasi-experimental retrospective cohort study

The effect of the employment of consultants in the Emergency Department on quality of care and equity – a quasi-experimental retrospective cohort study

Trends of CT utilisation in an emergency department in Taiwan: a 5-year retrospective study

Exploring the influence of gender, seniority and specialty on paper and computer-based feedback provision during mini-CEX assessments in a busy emergency department

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