Can different physicians providing urgent and non-urgent treatment improve patient flow in emergency department? - 22/11/17

Doi : 10.1016/j.ajem.2017.11.010

Flora Fei-Fei Yau, MD ^a,^{^{1
Fei-Fei Yau and Tsung-Cheng Tsai contributed equally to this work.}}, Tsung-Cheng Tsai, MD ^a,^{^{1
Fei-Fei Yau and Tsung-Cheng Tsai contributed equally to this work.}}, Yan-Ren Lin, MD, PhD ^b,^c,^d, Kuan-Han Wu, MD ^a, Yuan-Jhen Syue, MD ^e, Chao-Jui Li, MD, PhD ^a,^{^⁎}
^a Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
^b Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
^c School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
^d School of Medicine, Chung Shan Medical University, Taichung, Taiwan
^e Department of Anaesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

^⁎Corresponding author at: No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City 833, Taiwan.No. 123, Dapi Rd., Niaosong Dist.Kaohsiung City833Taiwan

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Abstract

Background

Emergency Department (ED) overcrowding is a worldwide problem, and it might be caused by prolonged patient stay in the ED. This study tried to analyze if different practice models influence patient flow in the ED.

Materials and methods

A retrospective, 1-year cohort study was conducted across two EDs in the largest healthcare system in Taiwan. A total of 37,580 adult non-trauma patients were involved in the study. The clinical practice between two ED practice models was compared. In one model, urgent and non-urgent patients were treated by different emergency physicians (EPs) separately (separated model). In the other, EPs treated all patients assigned randomly (merged model). The ED length of stay (LOS), diagnostic tool use (including laboratory examinations and computed tomography scans), and patient dispositions (including discharge, general ward admission, intensive care unit (ICU) admissions, and ED mortality) were selected as outcome indicators.

Result

Patients discharged from ED had 0.4h shorter ED LOS in the separated model than in merged model. After adjusting for the potential confounding factors through regression model, there was no difference of patient disposition of the two practice models. However, the separated model showed a slight decrease in laboratory examination use (adjusted odds ratio, 0.9; 95% confidence interval, 0.83–0.96) compared with the merged model.

Conclusion

The separated model had better patient flow than the merged model did. It decreased the ED LOS in ED discharge patients and laboratory examination use.

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Keywords : Emergency department, Emergency department crowding, Emergency practice model