LO68: Patterns and predictors of emergency physician productivity

Abstract

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.