title: Real time shift reporting by emergency physicians predicts overall ED performance.
abstract: OBJECTIVE
  To investigate factors associated with emergency physician perception of the shift and to determine whether these perceptions were predictors of overall daily emergency department (ED) performance indicators.
  
  
  METHODS
  This was an observational study conducted at an inner city ED in New South Wales. Shift reports completed by the emergency physician in charge at clinical handover times between February and July 2012 were included. Variables collected by the shift report included (1) total number of patients in ED, (2) number of patients in the ED with length of stay (LOS) greater than 4 h, (3) number of admitted patients, (4) number of patients waiting to be seen by a doctor and (5) medical staffing levels. Outcomes of interest for this study were shift perception scores (1=very poor to 5=very good) and daily ED performance measures. Performance measures were the proportion of patients admitted or discharged from ED within 4 h (National Emergency Access Target, NEAT) and the percentage of inpatient admissions leaving ED within 8 h of ED arrival time.
  
  
  RESULTS
  The number of patients in ED with LOS >4 h (OR 0.83, 95% CI 0.79 to 0.87, p value <0.001) and number of patients waiting to be seen (OR 0.92, 95% CI 0.88 to 0.95, p value <0.001) were the factors most strongly associated with shift perception score. After adjustment, the mean NEAT performance improved 6% for each incremental increase in average shift perception score (β=0.06 95% CI 0.04 to 0.07, p<0.001).
  
  
  CONCLUSIONS
  Shift reports and shift perceptions by emergency physicians may be used to predict overall ED performance.
authors.affiliation: Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Nadia
authors.initials: N
authors.lastname: Husain
authors.affiliation: Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bein
authors.affiliation: Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Green
authors.affiliation: NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Veillard
authors.affiliation: Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dinh
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D062209:Patient Handoff / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D013997:Time Factors
keywords: emergency department management