Emergency Department Rotational Patient Assignment - 14/12/17
, Christopher F. Stewart, MD a, b, Roshanak Didehban, MS a, b, Adam C. Bartley, MS c, Soroush Saghafian, PhD b, d, Vernon D. Smith, MD a, b, Scott M. Silvers, MD b, e, Ryan LeCheminant, BS a, Christopher A. Lipinski, MD a, bAbstract |
Study objective |
We compare emergency department (ED) operational metrics obtained in the first year of a rotational patient assignment system (in which patients are assigned to physicians automatically according to an algorithm) with those obtained in the last year of a traditional physician self-assignment system (in which physicians assigned themselves to patients at physician discretion).
Methods |
This was a pre-post retrospective study of patients at a single ED with no financial incentives for physician productivity. Metrics of interest were length of stay; arrival-to-provider time; rates of left before being seen, left subsequent to being seen, early returns (within 72 hours), and early returns with admission; and complaint ratio.
Results |
We analyzed 23,514 visits in the last year of physician self-assignment and 24,112 visits in the first year of rotational patient assignment. Rotational patient assignment was associated with the following improvements (percentage change): median length of stay 232 to 207 minutes (11%), median arrival to provider time 39 to 22 minutes (44%), left before being seen 0.73% to 0.36% (51%), and complaint ratio 9.0/1,000 to 5.4/1,000 (40%). There were no changes in left subsequent to being seen, early returns, or early returns with admission.
Conclusion |
In a single facility, the transition from physician self-assignment to rotational patient assignment was associated with improvement in a broad array of ED operational metrics. Rotational patient assignment may be a useful strategy in ED front-end process redesign.
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| Please see page 207 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Theodore R. Delbridge, MD, MPH |
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| Author contributions: SJT, CFS, and SS conceived of the study. SJT and RL obtained the data. ACB provided statistical advice. SJT drafted the article. All authors contributed significantly to article review and revision. SJT takes responsibility for the paper as a whole. |
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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 and provided the following details: Statistical analysis for this project was supported in part by grant UL1 TR000135 from the National Center for Advancing Translational Sciences. |
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| The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 67 - N° 2
P. 206-215 - febbraio 2016 Ritorno al numero
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