title: The impact of implementing the single provider model of emergency medicine in a paediatric hospital: a retrospective cohort analysis.
abstract: OBJECTIVE
  The Meyer Pediatric Hospital in Florence, Italy recently implemented the single provider model of emergency medicine. Prior to these changes, patients were triaged to a paediatric surgeon or paediatrician based on the complaint. The authors assess the outcomes of patients evaluated by surgeons prior to this change and compare them with those of patients seen by emergency physicians.
  
  
  METHODS
  A retrospective, cohort study was performed reviewing patients seen in the emergency department between 2005 and 2008 for the three most common surgical complaints encountered before the systems change: head trauma, testicular pain and abdominal pain. Outcomes include misdiagnoses, consultation rates, dispositions, imaging, interventions and surgeries.
  
  
  RESULTS
  A total of 2415 patient visits were included. Emergency physicians saw more patients (1388 vs 1027) and obtained more consultations (25.6% vs 8.1%) than surgeons. Patients triaged directly to surgeons were more likely to be admitted to the hospital (10.3% vs 7.6%), undergo urgent interventions (9.5% vs 6.7%), undergo surgery (8.0% vs 4.8%), have more radiographic images to evaluate head trauma (12.1% vs 5.3%), be misdiagnosed (1.0% vs 0.3%) and have more plain films for abdominal pain (3.1% vs 1.3%). There is an overall trend towards fewer missed diagnoses by emergency physicians (0.3% vs 0.9%), but this difference is only statistically significant in the abdominal pain subset analysis (p=0.032, combined data p=0.052).
  
  
  CONCLUSIONS
  The single provider model of emergency medicine where emergency physicians manage all patients presenting to the emergency department appears to be a safe and efficient model of emergency medical care.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. brad.crosby@imail.org
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Crosby
authors.forename: Francesco
authors.initials: F
authors.lastname: Mannelli
authors.forename: Mladen
authors.initials: M
authors.lastname: Nisavic
authors.forename: Alberto
authors.initials: A
authors.lastname: Passannante
authors.forename: David M
authors.initials: DM
authors.lastname: Cline
authors.forename: Charles P
authors.initials: CP
authors.lastname: Gillespie
authors.forename: Antonio
authors.initials: A
authors.lastname: Messineo
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Ban
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000628:therapy; D016009:Chi-Square Distribution; D002648:Child; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000628:therapy; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007558:Italy; D008297:Male; D017146:Models, Organizational; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013733:Testicular Diseases / Q000175:diagnosis / Q000628:therapy; D014218:Triage; D000078329:Workforce