Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN.
Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN.
Ann Emerg Med. 2016 Feb;67(2):206-15. doi: 10.1016/j.annemergmed.2015.07.008. Epub 2015 Oct 6.
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).
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.
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.
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.
我们比较了轮转患者分配系统(根据算法自动为患者分配医生)第一年获得的急诊科(ED)运营指标与传统医生自我分配系统(医生自行分配患者)最后一年获得的运营指标。
这是一项在单个 ED 进行的回顾性研究,没有对医生生产力的经济激励。感兴趣的指标包括停留时间;到达提供者的时间;未就诊前离开、就诊后离开、早期返回(72 小时内)和早期返回伴入院的比例;以及投诉比例。
我们分析了医生自我分配系统的最后一年的 23514 次就诊和轮转患者分配系统的第一年的 24112 次就诊。轮转患者分配与以下改善相关(百分比变化):中位数停留时间从 232 分钟缩短至 207 分钟(11%);中位数到达提供者的时间从 39 分钟缩短至 22 分钟(44%);未就诊前离开的比例从 0.73%降至 0.36%(51%);投诉比例从 9.0/1000 降至 5.4/1000(40%)。就诊后离开、早期返回或早期返回伴入院的比例没有变化。
在单个医疗机构中,从医生自我分配到轮转患者分配的转变与急诊科广泛的运营指标的改善相关。轮转患者分配可能是急诊科前端流程重新设计的有用策略。