title: Emergency Department Rotational Patient Assignment.
abstract: OBJECTIVE
  We compare emergency department (ED) operational metrics obtained in the first year of a rotational patient assignment system (in which patients are assigned to physicians automatically according to an algorithm) with those obtained in the last year of a traditional physician self-assignment system (in which physicians assigned themselves to patients at physician discretion).
  
  
  METHODS
  This was a pre-post retrospective study of patients at a single ED with no financial incentives for physician productivity. Metrics of interest were length of stay; arrival-to-provider time; rates of left before being seen, left subsequent to being seen, early returns (within 72 hours), and early returns with admission; and complaint ratio.
  
  
  RESULTS
  We analyzed 23,514 visits in the last year of physician self-assignment and 24,112 visits in the first year of rotational patient assignment. Rotational patient assignment was associated with the following improvements (percentage change): median length of stay 232 to 207 minutes (11%), median arrival to provider time 39 to 22 minutes (44%), left before being seen 0.73% to 0.36% (51%), and complaint ratio 9.0/1,000 to 5.4/1,000 (40%). There were no changes in left subsequent to being seen, early returns, or early returns with admission.
  
  
  CONCLUSIONS
  In a single facility, the transition from physician self-assignment to rotational patient assignment was associated with improvement in a broad array of ED operational metrics. Rotational patient assignment may be a useful strategy in ED front-end process redesign.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN. Electronic address: Traub.Stephen@Mayo.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Traub
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Stewart
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Roshanak
authors.initials: R
authors.lastname: Didehban
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Bartley
authors.affiliation: College of Medicine, Mayo Clinic, Rochester, MN; School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ.
authors.forename: Soroush
authors.initials: S
authors.lastname: Saghafian
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Vernon D
authors.initials: VD
authors.lastname: Smith
authors.affiliation: College of Medicine, Mayo Clinic, Rochester, MN; Department of Emergency Medicine, Mayo Clinic Florida, Jacksonville, FL.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Silvers
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ.
authors.forename: Ryan
authors.initials: R
authors.lastname: LeCheminant
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Lipinski
mesh_terms: D000465:Algorithms; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods*; D014850:Waiting Lists; D016526:Workload