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Medical expertise as a critical influencing factor on the length of stay in the ED: A retrospective cohort study

Overcrowding in the emergency departments (ED) is a significant issue associated with increased morbidity and mortality rates as well as decreased patient satisfaction. Length of stay (LOS) is both a cause and a result of overcrowding. In Israel, as there are few emergency medicine (EM) physicians,...

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Autores principales: Trotzky, Daniel, Tsur, Avishai M., Fordham, Daniel E., Halpern, Pinchas, Ironi, Avinoah, Ziv-Baran, Tomer, Cohen, Aya, Rozental, Lior, Or, Jacob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133210/
https://www.ncbi.nlm.nih.gov/pubmed/34106655
http://dx.doi.org/10.1097/MD.0000000000025911
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author Trotzky, Daniel
Tsur, Avishai M.
Fordham, Daniel E.
Halpern, Pinchas
Ironi, Avinoah
Ziv-Baran, Tomer
Cohen, Aya
Rozental, Lior
Or, Jacob
author_facet Trotzky, Daniel
Tsur, Avishai M.
Fordham, Daniel E.
Halpern, Pinchas
Ironi, Avinoah
Ziv-Baran, Tomer
Cohen, Aya
Rozental, Lior
Or, Jacob
author_sort Trotzky, Daniel
collection PubMed
description Overcrowding in the emergency departments (ED) is a significant issue associated with increased morbidity and mortality rates as well as decreased patient satisfaction. Length of stay (LOS) is both a cause and a result of overcrowding. In Israel, as there are few emergency medicine (EM) physicians, the ED team is supplemented with doctors from specialties including internal medicine, general surgery, orthopedics etc. Here we compare ED length of stay (ED-LOS), treatment time and decision time between EM physicians, internists and general surgeons. A retrospective cohort study was conducted examining the Emergency Department length of stay (ED-LOS) for all adult patients attending Sheba Medical Center ED, Israel, between January 1st, and December 31st, 2014. Using electronic medical records, data was gathered on patient age, sex, primary ED physician, diagnosis, eventual disposition, treatment time and disposition decision time. The primary outcome variable was ED-LOS relative to case physician specialty and level (ED, internal medicine or surgery; specialist or resident). Secondary analysis was conducted on time to treatment/ decision as well as ED-LOS relative to patient classification variables (internal medicine vs surgical diagnosis). Specialists were compared to specialists and residents to residents for all outcomes. Residents and specialists in either EM, internal medicine or general surgery attended 57,486 (51.50%) of 111,630 visits to Sheba Hospital's general ED. Mean ED-LOS was 4.12 ± 3.18 hours. Mean treatment time and decision time were 1.79 ± 1.82 hours, 2.84 ± 2.17 hours respectively. Amongst specialists, ED-LOS was shorter for EM physicians than for internal medicine physicians (mean difference 0.28 hours, 95% CI 0.14–0.43) and general surgeons (mean difference 0.63 hours, 95% CI 0.43–0.83). There was no statistical significance between residents when comparing outcomes. Increasing the number of EM specialists in the ED may support efforts to decrease ED-LOS, overcrowding and medical errors whilst increasing patient satisfaction and outcomes.
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spelling pubmed-81332102021-05-24 Medical expertise as a critical influencing factor on the length of stay in the ED: A retrospective cohort study Trotzky, Daniel Tsur, Avishai M. Fordham, Daniel E. Halpern, Pinchas Ironi, Avinoah Ziv-Baran, Tomer Cohen, Aya Rozental, Lior Or, Jacob Medicine (Baltimore) 3900 Overcrowding in the emergency departments (ED) is a significant issue associated with increased morbidity and mortality rates as well as decreased patient satisfaction. Length of stay (LOS) is both a cause and a result of overcrowding. In Israel, as there are few emergency medicine (EM) physicians, the ED team is supplemented with doctors from specialties including internal medicine, general surgery, orthopedics etc. Here we compare ED length of stay (ED-LOS), treatment time and decision time between EM physicians, internists and general surgeons. A retrospective cohort study was conducted examining the Emergency Department length of stay (ED-LOS) for all adult patients attending Sheba Medical Center ED, Israel, between January 1st, and December 31st, 2014. Using electronic medical records, data was gathered on patient age, sex, primary ED physician, diagnosis, eventual disposition, treatment time and disposition decision time. The primary outcome variable was ED-LOS relative to case physician specialty and level (ED, internal medicine or surgery; specialist or resident). Secondary analysis was conducted on time to treatment/ decision as well as ED-LOS relative to patient classification variables (internal medicine vs surgical diagnosis). Specialists were compared to specialists and residents to residents for all outcomes. Residents and specialists in either EM, internal medicine or general surgery attended 57,486 (51.50%) of 111,630 visits to Sheba Hospital's general ED. Mean ED-LOS was 4.12 ± 3.18 hours. Mean treatment time and decision time were 1.79 ± 1.82 hours, 2.84 ± 2.17 hours respectively. Amongst specialists, ED-LOS was shorter for EM physicians than for internal medicine physicians (mean difference 0.28 hours, 95% CI 0.14–0.43) and general surgeons (mean difference 0.63 hours, 95% CI 0.43–0.83). There was no statistical significance between residents when comparing outcomes. Increasing the number of EM specialists in the ED may support efforts to decrease ED-LOS, overcrowding and medical errors whilst increasing patient satisfaction and outcomes. Lippincott Williams & Wilkins 2021-05-14 /pmc/articles/PMC8133210/ /pubmed/34106655 http://dx.doi.org/10.1097/MD.0000000000025911 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/)
spellingShingle 3900
Trotzky, Daniel
Tsur, Avishai M.
Fordham, Daniel E.
Halpern, Pinchas
Ironi, Avinoah
Ziv-Baran, Tomer
Cohen, Aya
Rozental, Lior
Or, Jacob
Medical expertise as a critical influencing factor on the length of stay in the ED: A retrospective cohort study
title Medical expertise as a critical influencing factor on the length of stay in the ED: A retrospective cohort study
title_full Medical expertise as a critical influencing factor on the length of stay in the ED: A retrospective cohort study
title_fullStr Medical expertise as a critical influencing factor on the length of stay in the ED: A retrospective cohort study
title_full_unstemmed Medical expertise as a critical influencing factor on the length of stay in the ED: A retrospective cohort study
title_short Medical expertise as a critical influencing factor on the length of stay in the ED: A retrospective cohort study
title_sort medical expertise as a critical influencing factor on the length of stay in the ed: a retrospective cohort study
topic 3900
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133210/
https://www.ncbi.nlm.nih.gov/pubmed/34106655
http://dx.doi.org/10.1097/MD.0000000000025911
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