title: The effects of a physician slowdown on emergency department volume and treatment.
abstract: OBJECTIVE
  In February 2003, many physicians in New Jersey participated in a work slowdown to publicize large increases in malpractice premiums and generate support for legislative reform. It was anticipated that the community physician slowdown (hereafter referred to as "slowdown") would increase emergency department (ED) visits. The authors' goal was to help others prepare for anticipated increases in ED volumes by describing the preparatory staffing changes made and quantifying increases in ED volume.
  
  
  METHODS
  This was a retrospective cohort study performed at a New Jersey suburban teaching hospital with 70,000 annual visits. Consecutive patients seen by emergency physicians were enrolled. The authors extracted patient visit data from the computerized tracking system and analyzed hours worked by personnel, patient volumes, admission rates, and patient throughput times. Variables from each day of the slowdown with baseline values for the same day of the week for the four weeks before and after the slowdown were compared. A Bonferroni correction was used, with p < 0.01 considered statistically significant.
  
  
  RESULTS
  Total patient volume increased 79% from baseline (95% confidence interval [CI] = 20% to 137%). Pediatric volume increased 223% (95% CI = 171% to 274%). Overall admission rate decreased 29% compared with baseline (95% CI = 8% to 51%). Patient throughput times did not change significantly. Similar results for these variables were found for the second through fourth days of the slowdown.
  
  
  CONCLUSIONS
  Emergency department visits, especially pediatric visits, increased markedly during the community physician slowdown. Anticipatory increases in staffing effectively prevented increased throughput times.
authors.affiliation: Department of Emergency Medicine, 100 Madison Avenue, Box 8, Morristown Memorial Hospital, Morristown, NJ 07960, USA. briwalsh10@yahoo.com
authors.forename: Brian
authors.initials: B
authors.lastname: Walsh
authors.forename: Barnet
authors.initials: B
authors.lastname: Eskin
authors.forename: John
authors.initials: J
authors.lastname: Allegra
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rothman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Junker
mesh_terms: D000328:Adult; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D008318:Malpractice / Q000191:economics; D009515:New Jersey; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013317:Strikes, Employee; D013997:Time Factors