title: Emergency departments in The Netherlands: is there a difference in emergency departments with and without emergency physicians? a cross-sectional web-based survey.
abstract: BACKGROUND
  There is a growing interest in emergency departments (EDs) and the development of emergency medicine in The Netherlands. In the last decade several policy reports have stated that the quality of emergency care should be improved and that emergency physicians (EPs) play a large role in the quality improvement. The Netherlands Society of Emergency Physicians (NVSHA) has developed an emergency medicine training program, which has been nationally recognized since 2009. Nevertheless, not all EDs are staffed with EPs yet. This study aimed to explore differences between Dutch EDs with EPs and those without EPs.
  
  
  METHODS
  A cross-sectional web-based survey was performed on data over the year 2008 or 2009 in all 105 Dutch hospitals with an emergency department. We documented which ED-specific courses were attended by physicians working in the ED (list of 3 courses) and which clinical audit activities were implemented (list of 6 activities). The choice of courses and clinical audits was based on those mentioned in published quality reports and in national debates on emergency care. We compared EDs with and without EPs. The final analysis was based on a linear regression analysis, controlling for ED size and having an EP training program. We considered P < 0.05 significant.
  
  
  RESULTS
  Our survey's response rate was 67%. EPs worked significantly more often in larger EDs. The linear regression analysis shows that the total number of courses attended by physicians was on average 0.51 higher (P = 0.000) in EDs with EPs than in EDs without EPs, and the total number of implemented clinical audits was on average 0.49 higher (P = 0.008). After controlling for potential confounders, the effect of both the composite number of courses attended (P = 0.001) and the composite number of implemented clinical activities (P = 0.032) remained significant.
  
  
  CONCLUSIONS
  This study shows that EPs are significantly more present in larger EDs and in EDs where there is more continuing professional education and where there are more clinical audit activities. Our findings suggest that the presence of emergency physicians is positively associated with the quality of emergency care, but prospective research is required to examine causality.
authors.affiliation: Catharina Hospital, Eindhoven, Michelangelolaan 2, PO box 1350, 5602ZA Eindhoven, the Netherlands. wendy.thijssen@cze.nl.
authors.forename: Wendy Amh
authors.initials: WA
authors.lastname: Thijssen
authors.forename: Jan
authors.initials: J
authors.lastname: Koetsenruijter
authors.forename: Paul
authors.initials: P
authors.lastname: Giesen
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing