title: Development of a novel information and communication technology system to compensate for a sudden shortage of emergency department physicians.
abstract: BACKGROUND
  A sudden shortage of physician resources due to overwhelming patient needs can affect the quality of care in the emergency department (ED). Developing effective response strategies remains a challenging research area. We created a novel system using information and communication technology (ICT) to respond to a sudden shortage, and tested the system to determine whether it would compensate for a shortage.
  
  
  METHODS
  Patients (n = 4890) transferred to a level I trauma center in Japan during 2012-2015 were studied. We assessed whether the system secured the necessary physicians without using other means such as phone or pager, and calculated fulfillment rate by the system as a primary outcome variable. We tested for the difference in probability of multiple casualties among total casualties transferred to the ED as an indicator of ability to respond to excessive patient needs, in a secondary analysis before and after system introduction.
  
  
  RESULTS
  The system was activated 24 times (stand-by request [n = 12], attendance request [n = 12]) in 24 months, and secured the necessary physicians without using other means; fulfillment rate was 100%. There was no significant difference in the probability of multiple casualties during daytime weekdays hours before and after system introduction, while the probability of multiple casualties during night or weekend hours after system introduction significantly increased compared to before system introduction (4.8% vs. 12.9%, P < 0.0001). On the whole, the probability of multiple casualties increased more than 2 times after system introduction 6.2% vs. 13.6%, P < 0.0001).
  
  
  CONCLUSIONS
  After introducing the system, probability of multiple casualties increased. Thus the system may contribute to improvement in the ability to respond to sudden excessive patient needs in multiple causalities.
  
  
  CONCLUSIONS
  A novel system using ICT successfully secured immediate responses from needed physicians outside the hospital without increasing user workload, and increased the ability to respond to excessive patient needs. The system appears to be able to compensate for a shortage of physician in the ED due to excessive patient transfers, particularly during off-hours.
authors.affiliation: Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan.|Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan. taka.nakada@nifty.com.|Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan. taka.nakada@nifty.com.
authors.forename: Taka-Aki
authors.initials: TA
authors.lastname: Nakada
authors.affiliation: Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuma
authors.affiliation: Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Nakao
authors.affiliation: Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Masunaga
authors.affiliation: Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomita
authors.affiliation: Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Matsumura
authors.affiliation: Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Mizushima
authors.affiliation: Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Matsuoka
mesh_terms: D040421:Cell Phone; D004189:Disaster Planning; D034742:Electronic Mail; D004636:Emergency Service, Hospital; D006801:Humans; D020407:Internet; D007564:Japan; D054527:Mass Casualty Incidents; D010561:Personnel Staffing and Scheduling; D010820:Physicians / Q000600:supply & distribution*; D011446:Prospective Studies; D012984:Software; D000078329:Workforce
keywords: Cloud server; Critical care; Information sharing; Life threatening; Mail; Mass casualty; Mobile phone; Night; Trauma