Clinical Resource Utilization and Decision Making in the Emergency Department As a Function of Time Into Shift Open Access
Axelson, Daniel James (2013)
Abstract
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.
Methods:
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.
Results:
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.
Conclusion:
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 15About this Master's Thesis
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