scholarly journals LO68: Patterns and predictors of emergency physician productivity

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S30-S31
Author(s):  
S. Campbell ◽  
S. Weerasinghe
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Ct Scan ◽  
Resource Utilization ◽  
Emergency Physician ◽  
X Ray ◽  
Workload Measurement ◽  
Number Of Patients ◽  
Return Visits

Introduction: Emergency Physician (EP) performance comprises both quality of care and quantity of patients seen in a set time. Emergency Department (ED) overcrowding increases the importance of the ability of EPs to see patients as rapidly as is safely possible. Maximizing efficiency requires an understanding of variables that are associated with individual physician performance. While using the incidence of return visits within 48 hours as a quality measure is controversial, repeat visits do consume ED resources. Methods: We analysed the practice variables of 85 EPs working at a single academic ED, for the period from June 1, 2013 to May 31, 2017, using data from an emergency department information system (EDIS). Variables analysed included: number of shifts worked, number of patients seen per hour (pt/hr), an adjusted workload measurement (assigning a higher score to CTAS 1-3 patients), percentage of patients whose care involved an ED learner, and the percentage of patients who returned to the ED within 48 hours of ED discharge. Resource utilization was measured by percentage of diagnostic imaging (ultra sound (US), CT scan (CT), x-ray (XR)) ordered and percentage of patients referred to consulting services. We performed principal component analyses to identify bench marks of resource use, demographic (age, EM qualification, gender) and other practice related predictors of performances. Results: Mean pt/hr differed significantly by EM Qualification for CTAS 2-4, with 1.71/hr (95% Confidence Interval=1.63-1.77) by FRCPS physicians, compared to 1.89/hr by CCFP(EM) (CI=1.81-1.97). There were no differences for CTAS 1 and 5. Other variables associated with a significantly lower pt/hr, included a greater use of imaging, (CT: p=0.0003, XR: p=0.0008) although this was did not reach statistical significance with US (p=0.06%). Female gender, older age, number of patient consultations for CTAS 3 and more patients seen by a learner were all associated with lower pt/hr. Pt/hr was a better predictor (R2=45%) for EP resource utilization than adjusted workload measurement (R2 =35%). Higher use of CT was associated with fewer return visits in <48 hrs (0.13% lower). Male gender, younger age, number of patient consultation for CTAS 3 and fewer patients seen by a learner were all associated with an increase in return visits. Conclusion: We found a significant difference in pt/hr rates and return visits within 48 hours between EPs with different age ranges, gender, and EM certification. Increased use of CT scan and x-ray, and consultation for patients CTAS 3 were associated with lower pt/hr. Return visit rates also varied in association with diagnostic imagine use, age, gender and number of patients seen by a learner. Further research is needed to assess the association with these variables on quality of care.

scholarly journals P128: Emergency physician efficiency benchmarking and diagnostic imaging use

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S110-S110
Author(s):  
S. Weerasinghe ◽  
N. Chandratilleke ◽  
S. Campbell
Keyword(s):  
Diagnostic Imaging ◽  
Optimal Performance ◽  
Audit And Feedback ◽  
X Rays ◽  
X Ray ◽  
Use Of Resources ◽  
Quartile Range ◽  
Workload Measurement ◽  
Number Of Patients ◽  
Return Visits

Introduction: As part of our audit and feedback process, Emergency Physicians (EP) are provided feedback on flow metrics and resource utilization. We analysed the relationship between two specific metrics (adjusted workload measurement (AWM), with the number of patients seen per hour adjusted according to CTAS, and percentage of revisits within 72 hours and diagnostic imaging use. Unfortunately, we are unable to evaluate quality of care, nor appropriateness of DI indication at this stage. Methods: We used data from 86 physicians at an academic ED, from June 1, 2015 to May31, 2017. The Data Envelope Analysis (DEA) model incorporated performance quality measures as outputs and efficiency measures as inputs. DEA is a method widely used in physician performance analysis. The method provides a score (optimal performance efficiency-OPE) for each EP based on maximization of the performance (AWM) in proportion to the combination of efficient use of resources, diagnostic imaging (DI). The score was used to regress against demographic characteristics and training. Results: The median AWM was 6.8 (quartiles Q1-Q3 = 6.4-7.4) with the median diagnostic imaging use of percentages of CT (median = 10.1, 8.6-11.9), US (median = 4.7, 3.6-5.6) and x-ray (80, 74-84). The EPs who had highest AWM combined with least use of DI (OPE = 100%), provided median AWM of 9.1 (range 8.9-9.7) with percentage CT, US and x-ray medians at 5.8% (range 5.8-6.2), 2.7% (range 2.4-3.6) and 59% (range 59-72). These provided benchmarks for optimal performance indicators. We found statistically significant differences of OPE scores based on gender (men 4.1 times higher, p < 0.001) and degree (RCPS < CCFPEM, Other < CCFPEM, p < 0.001). Overall AWM diminishes at the rate of 14% (95%CI: 9-20%) for a combination of 100 DI tests ordered. In order to reach the optimal level of performance, to reach an OPE of 100%, the median CT use percentage needs to be reduced by 6% (quartile range 3.9- 7.7%), US by 2.2% (quartile range 1.5-3.4%) and x-rays by 37.2% (quartile range: 26.8-44.3%). Return visit rates were not associated with DI use, possibly due to homogeneity in the percentage of return visits. Conclusion: We found significant performance variations in terms of average workload measurement in proportion to the weighted average of diagnostic imaging use, with increased use of DI being associated with decreasing AWM. Percentage of return visits does not appear to be useful as a performance indicator.

The ENT emergency clinic: does senior input matter?

2012 ◽  
Vol 127 (1) ◽  
pp. 15-19 ◽  
Author(s):  
A Mirza ◽  
L McClelland ◽  
M Daniel ◽  
N Jones
Keyword(s):  
Quality Of Care ◽  
Discharge Rate ◽  
Surrogate Marker ◽  
Operating Theatre ◽  
Number Of Children ◽  
Discharge Rates ◽  
Time Period ◽  
Number Of Patients

AbstractBackground:Many ENT conditions can be treated in the emergency clinic on an ambulatory basis. Our clinic traditionally had been run by foundation year two and specialty trainee doctors (period one). However, with perceived increasing inexperience, a dedicated registrar was assigned to support the clinic (period two). This study compared admission and discharge rates for periods one and two to assess if greater registrar input affected discharge rate; an increase in discharge rate was used as a surrogate marker of efficiency.Method:Data was collected prospectively for patients seen in the ENT emergency clinic between 1 August 2009 and 31 July 2011. Time period one included data from patients seen between 1 August 2009 and 31 July 2010, and time period two included data collected between 1 August 2010 and 31 July 2011.Results:The introduction of greater registrar support increased the number of patients that were discharged, and led to a reduction in the number of children requiring the operating theatre.Conclusion:The findings, which were determined using clinic outcomes as markers of the quality of care, highlighted the benefits of increasing senior input within the ENT emergency clinic.

scholarly journals Pain management after lung surgery

2014 ◽  
Vol 4 (1) ◽  
Author(s):  
Maria Frödin ◽  
Margareta Warrén Stomberg
Keyword(s):  
Quality Of Care ◽  
Pain Management ◽  
Postoperative Pain ◽  
Severe Pain ◽  
Postoperative Pain Management ◽  
Lung Surgery ◽  
Moderate Pain ◽  
Number Of Patients ◽  
Severe Postoperative Pain

Pain management is an integral challenge in nursing and includes the responsibility of managing patients’ pain, evaluating pain therapy and ensuring the quality of care. The aims of this study were to explore patients’ experiences of pain after lung surgery and evaluate their satisfaction with the postoperative pain management. A descriptive design was used which studied 51 participants undergoing lung surgery. The incidence of moderate postoperative pain varied from 36- 58% among the participants and severe pain from 11-26%, during their hospital stay. Thirty-nine percent had more pain than expected. After three months, 20% experienced moderate pain and 4% experienced severe pain, while after six months, 16% experienced moderate pain. The desired quality of care goal was not fully achieved. We conclude that a large number of patients experienced moderate and severe postoperative pain and more than one third had more pain than expected. However, 88% were satisfied with the pain management. The findings confirm the severity of pain experienced after lung surgery and facilitate the apparent need for the continued improvement of postoperative pain management following this procedure.

scholarly journals Ordinal outcome analysis improves the detection of between-hospital differences in outcome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. E. Ceyisakar ◽  
N. van Leeuwen ◽  
Diederik W. J. Dippel ◽  
Ewout W. Steyerberg ◽  
H. F. Lingsma
Keyword(s):  
Logistic Regression ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Statistical Power ◽  
Ordinal Scale ◽  
Efficiency Gain ◽  
Number Of Patients ◽  
Dichotomous Outcomes ◽  
Ordinal Outcome

Abstract Background There is a growing interest in assessment of the quality of hospital care, based on outcome measures. Many quality of care comparisons rely on binary outcomes, for example mortality rates. Due to low numbers, the observed differences in outcome are partly subject to chance. We aimed to quantify the gain in efficiency by ordinal instead of binary outcome analyses for hospital comparisons. We analyzed patients with traumatic brain injury (TBI) and stroke as examples. Methods We sampled patients from two trials. We simulated ordinal and dichotomous outcomes based on the modified Rankin Scale (stroke) and Glasgow Outcome Scale (TBI) in scenarios with and without true differences between hospitals in outcome. The potential efficiency gain of ordinal outcomes, analyzed with ordinal logistic regression, compared to dichotomous outcomes, analyzed with binary logistic regression was expressed as the possible reduction in sample size while keeping the same statistical power to detect outliers. Results In the IMPACT study (9578 patients in 265 hospitals, mean number of patients per hospital = 36), the analysis of the ordinal scale rather than the dichotomized scale (‘unfavorable outcome’), allowed for up to 32% less patients in the analysis without a loss of power. In the PRACTISE trial (1657 patients in 12 hospitals, mean number of patients per hospital = 138), ordinal analysis allowed for 13% less patients. Compared to mortality, ordinal outcome analyses allowed for up to 37 to 63% less patients. Conclusions Ordinal analyses provide the statistical power of substantially larger studies which have been analyzed with dichotomization of endpoints. We advise to exploit ordinal outcome measures for hospital comparisons, in order to increase efficiency in quality of care measurements. Trial registration We do not report the results of a health care intervention.

Quality of Care in an Emergency Department from the Perspective of Traffic Injury Patients

2006 ◽  
Vol 32 (2) ◽  
pp. 127 ◽  
Author(s):  
Carin Franzén ◽  
Ulf Björnstig ◽  
Christine Bruhlin ◽  
Lilian Jansson ◽  
Hans Stenlund
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Traffic Injury

Piloting a Statewide Emergency Department Take‐Home Naloxone Program: Improving the Quality of Care for Patients at Risk of Opioid Overdose

2021 ◽  
Author(s):  
Aaron Dora‐Laskey ◽  
Joan Kellenberg ◽  
Chin Hwa Dahlem ◽  
Elizabeth English ◽  
Monica Gonzalez Walker ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Quality Of Care ◽  
Opioid Overdose ◽  
Patients At Risk
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