Clinical Resource Utilization and Decision Making in the Emergency Department As a Function of Time Into Shift Open Access

Axelson, Daniel James (2013)

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Study Objective:
Management of abdominal pain and chest pain in the emergency department (ED) presents a significant challenge. Time into shift is known to affect ED physicians' clinical productivity, but its effect on clinical decision-making is unknown. We investigated whether physician's time into shift independently affected admission and diagnostic resource use among patients treated for non-traumatic abdominal and chest pain in the ED.
Patients with abdominal pain and chest pain seen at two large, university hospital EDs were characterized as having been treated at the beginning (first 5 hours), or the end (last 3 hours) of a physician's 8-hour shift. The two groups' rates of admission and CT scan utilization were analyzed using multivariable analyses with results expressed as adjusted odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). Stratified analysis across levels of triage acuity accounted for differences in patient population.
There was a statistically significant inverse association between time into shift and the likelihood of receiving a CT scan among abdominal and chest pain patients. Using beginning of shift as reference, the adjusted OR for the end of shift was 0.90 (95% CI: 0.82-0.99). The corresponding ORs reflecting the association between time into shift and admissions to the hospital or to the observation unit were 1.05 (95% CI: 0.93-1.18) and 1.04 (95% CI: 0.93-1.17), respectively.
This study demonstrates that time into shift may be a determinant of clinical resource utilization, but it is not a predictor of hospitalization. Time into shift may be considered when designing formal patient pickup and handoff protocols.

Table of Contents

Table of Contents

Introduction 1 Methods 2 Results 4 Discussion 5 References 8 Table 1 11 Table 2 12 Table 3 13 Table 4 14 Figure 1 15

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