IMPACT OF PHYSICIAN FEEDBACK ON EMERGENCY DEPARTMENT RESOURCE USE, QUALITY AND EFFICIENCY Öffentlichkeit
Jain, Shabnam (2012)
Abstract
Background: Emergency
Departments (ED) carry a perception of excessive diagnostic
testing
and therapies. Variation in physician practice is widely prevalent
and highlights opportunities
for quality improvement and cost containment. Monitoring resources
used in the management of
common pediatric ED conditions has been suggested as an ED quality
metric.
Objectives: (1) To develop a tool for comprehensive
feedback to ED physicians on their practice
patterns relative to peers; and (2) To evaluate the impact of
physician feedback on ED resource
use, quality and efficiency.
Methods: Data on resource use by physicians were extracted
from electronic medical records at 2
tertiary pediatric EDs for 4 common conditions in mid-acuity: 1)
Fever 2) Head Injury 3)
Respiratory illness, 4) Gastroenteritis. Condition-relevant
resource use was tracked for Lab tests
(blood count, chemistry, CRP), Imaging (chest X-ray, abdominal
X-ray, head CT scan,
abdominal/pelvic CT scan), intravenous fluids, parenteral
antibiotics, and intravenous
ondansetron; hospital admission was tracked for all 4 conditions.
The outcome measure was ED
Length of stay (LOS) and the balancing measure was 72-hr return to
ED (RR).
Scorecards were constructed using box plots showing physicians
their practice patterns relative to
peers. Blinded scorecards were distributed quarterly for 5
quarters. Pre- Post-intervention
analysis was performed with Sep 1, 2010 as the intervention date.
Fisher-exact and Wilcoxon
Rank sum tests were used for overall impact. Trend analysis was
conducted to account for
physician-specific random effects in clustering, patient-level
covariates, and time trends.
Results: We analyzed 48,538 patient visits (21,612 Pre and
26,926 Post) seen by 121 physicians
(mean 401 patients/physician). Overall, reduction was noted in use
of abdominal/pelvic CT
scans, head CT scans, chest X-rays, IV antibiotics and IV
Ondansetron (p<0.001 for all).
Hospital admission rate decreased from 7.4% to 6.7% (p<0.001).
ED LOS decreased from 129 to
125 min (p<0.001). 72-hr RR changed from 2.2% to 2.0%.
Significant change in trends was
noted for admission to hospital (p<0.05), use of lab tests
(p<0.001), and use of IV antibiotics
(p<0.05).
Conclusion: Our study shows reduction in resource use for
commonly seen conditions in the
pediatric ED after providing ED physicians with feedback on
practice patterns relative to peers.
Reduced resource use did not adversely affect quality of care (LOS
or Return rate).
Table of Contents
1. Thesis Manuscript
2. References
3. Tables and Figures
About this Master's Thesis
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