title: The Impact of Emergency Physician Seniority on Clinical Efficiency, Emergency Department Resource Use, Patient Outcomes, and Disposition Accuracy.
abstract: The ability of emergency physicians (EPs) to continue within the specialty has been called into question due to high stress in emergency departments (EDs).The purpose of this study was to investigate the impact of EP seniority on clinical performance.A retrospective, 1-year cohort study was conducted across 3 EDs in the largest health-care system in Taiwan. Participants included 44,383 adult nontrauma patients who presented to the EDs. Physicians were categorized as junior, intermediate, and senior EPs according to ≤5, 6 to 10, and >10 years of ED work experience. The door-to-order and door-to-disposition time were used to evaluate EP efficiency. Emergency department resource use indicators included diagnostic investigations of electrocardiography, plain film radiography, laboratory tests, and computed tomography scans. Discharge and mortality rates were used as patient outcomes. Disposition accuracy was evaluated by ED revisit rate.Senior EPs were found to have longer door-to-order (11.3, 12.4 minutes) and door-to-disposition (2, 1.7 hours) time than nonsenior EPs in urgent and nonurgent patients (junior: 9.4, 10.2 minutes and 1.7, 1.5 hours; intermediate: 9.5, 10.7 minutes and 1.7, 1.5 hours). Senior EPs tended to order fewer electrocardiograms, radiographs, and computed tomography scans in nonurgent patients. Adjusting for age, sex, disease acuity, and medical setting, patients treated by junior and intermediate EPs had higher mortality in the ED (adjusted odd ratios, 1.5 and 1.6, respectively).Compared with EPs with ≤10 years of work experience, senior EPs take more time for order prescription and patient disposition, use fewer diagnostic investigations, particularly for nonurgent patients, and are associated with a lower ED mortality rate.
authors.affiliation: From the Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (C-JL, T-CT, K-HW); Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan (C-JL, C-HL); Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (C-HL); Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (Y-JS); Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan (Y-RL); School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (Y-RL); and School of Medicine, Chung Shan Medical University, Taichung, Taiwan (Y-RL).
authors.forename: Chao-Jui
authors.initials: CJ
authors.lastname: Li
authors.forename: Yuan-Jhen
authors.initials: YJ
authors.lastname: Syue
authors.forename: Tsung-Cheng
authors.initials: TC
authors.lastname: Tsai
authors.forename: Kuan-Han
authors.initials: KH
authors.lastname: Wu
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: Yan-Ren
authors.initials: YR
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004526:Efficiency; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013624:Taiwan; D013997:Time Factors