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

Axelson, Daniel James (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/cr56n1826?locale=zh
Published

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 15

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