IMPACT OF PHYSICIAN FEEDBACK ON EMERGENCY DEPARTMENT RESOURCE USE, QUALITY AND EFFICIENCY Public

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

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Health Sciences, Health Care Management
Mot-clé	Physician performance Resource use Quality improvement Practice variation
Committee Chair / Thesis Advisor	Howard, David H, Emory University
Committee Members	Johnson, Brent, Emory University
Partnering Agencies	Hospital or other health care provider

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