Variability in Emergency Department Procedure Rates and Distributions in a Regional Health System: A Cross-Sectional Observational Study - 19/04/23
, Sayon Dutta, MD, MPH a, b, Sangeeta Sakaria, MD, MPH c, Dustin S. McEvoy, BS b, Daniel J. Egan, MD a, cAbstract |
Study Objective |
Procedural competency is essential to the practice of emergency medicine. However, there are limited data quantifying emergency department procedural volumes to inform the work of educators and credentialing bodies. In this study, we characterize procedural scope and volume in a regional health care system and compare rates between practice settings and over time.
Methods |
Cross-sectional data were acquired from electronic medical records of a regional health care system from March 2017 through February 2022. Nonspecific entries, esoteric procedures, and nonprocedural clinical skills were excluded. Procedural rates were compared: (1) between academic and community hospitals, (2) across study years, and (3) across seasons. Analyses were repeated for pediatric encounters, and with study year 4 removed to assess the influence of the first year of the coronavirus disease 2019 pandemic on results.
Results |
There were 131,976 instances of 40 qualifying procedures in 1,979,935 unique visits across 9 EDs. Several high-acuity procedures had similar rates in academic and community settings, including cardiac pacing, cricothyrotomy, and lateral canthotomy. Year-over-year procedural rates were stable or increasing for most procedures, with a notable exception of lumbar puncture. Most procedures did not have significant seasonal variation, and most findings were stable when study year 4 was removed from the analysis.
Conclusion |
All procedures were performed in all settings and rates of several emergent procedures were similar in both settings, underscoring the importance of broad procedural competence for all emergency physicians. Educators and credentialing organizations can use these data to inform decisions regarding curriculum design and certification requirements.
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| Please see page 625 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Ambrose H. Wong, MD, MSEd. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: ES, SD, and DE conceived the study and designed the methodology. SD supervised data collection. DM extracted the data. ES managed the data, including quality control. ES and SD designed the statistical approach to data analysis. ES, SD, SS, and DJE analyzed the data. ES and SS drafted the manuscript, and all authors contributed substantially to its revision. ES takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
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| Publishing dates: Received for publication June 30, 2022. Revisions received September 19, 2022, and November 17, 2022. Accepted for publication December 12, 2022. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 81 - N° 5
P. 624-629 - mai 2023 Retour au numéro
Article précédent
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