Abstract
Objective
To describe the relationship between emergency department resource utilization and
admission rate at the level of the individual physician.
Methods
Retrospective observational study of physician resource utilization and admitting
data at two emergency departments. We calculated observed to expected (O/E) ratios
for four measures of resource utilization (intravenous medications and fluids, laboratory
testing, plain radiographs, and advanced imaging studies) as well as for admission
rate. Expected values reflect adjustment for patient- and time-based variables. We
compared O/E ratios for each type of resource utilization to the O/E ratio for admission
for each provider. We report degree of correlation (slope of the trendline) and strength
of correlation (adjusted R2 value) for each association, as well as categorical results after clustering physicians
based on the relationship of resource utilization to admission rate.
Results
There were statistically significant positive correlations between resource utilization
and physician admission rate. Physicians with lower resource utilization rates were
more likely to have lower admission rates, and those with higher resource utilization
rates were more likely to have higher admission rates.
Conclusions
In a two-facility study, emergency physician resource utilization and admission rate
were positively correlated: those who used more ED resources also tended to admit
more patients. These results add to a growing understanding of emergency physician
variability.
Keywords
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References
- Practice variation and effects of e-mail–only performance feedback on resource use in the emergency department.Acad Emerg Med. 2017; 24: 948-956https://doi.org/10.1111/acem.13211
- Variation in use of all types of computed tomography by emergency physicians.Am J Emerg Med. 2013; 31: 1437-1442https://doi.org/10.1016/j.ajem.2013.07.003
- How (ED) admission decisions differ when the same physician works in two different emergency department.Am J Emerg Med. 2017; 35: 970-973https://doi.org/10.1016/j.ajem.2017.01.067
- The relative contribution of provider and ED-level factors to variation among the top 15 reasons for ED admission.Am J Emerg Med. 2017; 35: 1291-1297https://doi.org/10.1016/j.ajem.2017.03.074
- Emergency department rotational patient assignment.Ann Emerg Med. 2016; 67: 206-215https://doi.org/10.1016/j.annemergmed.2015.07.008
- Emergency department physician-level and hospital-level variation in admission rates.Ann Emerg Med. 2013; 61: 638-643https://doi.org/10.1016/j.annemergmed.2013.01.016
- Scan, admit, or both? Is there a correlation between admission rate and computed tomography utilization?.Ann Emerg Med. 2017; 70: S8-S9https://doi.org/10.1016/j.annemergmed.2017.07.042
- The association between physician risk tolerance and imaging use in abdominal pain.Am J Emerg Med. 2009; 27: 552-557https://doi.org/10.1016/j.ajem.2008.04.031
- Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia.Ann Emerg Med. 2005; 46: 525-533https://doi.org/10.1016/j.annemergmed.2005.04.016
- Embedded clinical decision support in electronic health record decreases use of high cost imaging in the emergency department: EmbED study.Acad Emerg Med. 2017; 24: 1-7https://doi.org/10.1111/acem.13195
- Cherry picking patients: examining the interval between patient rooming and resident self-assignment.Acad Emerg Med. 2016; 23: 679-684https://doi.org/10.1111/acem.12895
Article Info
Publication History
Published online: July 20, 2018
Accepted:
July 20,
2018
Received in revised form:
June 30,
2018
Received:
May 1,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
