Department of Family Medicine, Queen's University, Kingston, Canada.
Emergency Services, Southlake Regional Health Centre, Newmarket, Canada.
Emerg Med J. 2018 Jan;35(1):5-11. doi: 10.1136/emermed-2017-206809. Epub 2017 Aug 8.
We created Physician Navigators in our ED to help improve emergency physician (EP) productivity. We aimed to quantify the effect of Physician Navigators on measures of EP productivity: patient seen per hour (Pt/hr), and turn-around time (TAT) to discharge. Secondary objectives included examining their impact on measures of ED throughput for non-resuscitative patients: ED length of stay (LOS), door-to-physician time and left-without-being-seen rates (LWBS).
In this retrospective study, 6845 clinical shifts worked by 20 EPs at a community ED in Newmarket, Canada from 1 January 2012 to 31 March 2015 were evaluated. Using a clustered design, we compared productivity measures between shifts with and without Physician Navigators, by physician. We used a linear mixed model to examine mean changes in Pt/hr and TAT to discharge for EPs who employed Physician Navigators. For secondary objectives, autoregressive modelling was performed to compare ED throughput metrics before and after the implementation of Physician Navigators for non-resuscitative patients.
Patient volumes increased by 20 patients per day (p<0.001). Mean Pt/hr increased by 1.07 patients per hour (0.98 to 1.16, p<0.001). The mean TAT to discharge decreased by 10.6 min (-13.2 to -8.0, p<0.001). After implementation of the Physician Navigator programme, overall mean LOS for non-resuscitative patients decreased by 2.6 min (p=0.007), and mean door-to-physician time decreased by 7.4 min (p<0.001). LBWS rates decreased from 1.13% to 0.63% of daily patient volume (p<0.001).
Despite an ED volume increase, the use of a Physician Navigator was associated with significant improvements in EP productivity, and significant reductions in ED throughput times.
我们在急诊科设立了医师导航员，以帮助提高急诊医师的工作效率。我们旨在量化医师导航员对以下急诊医师工作效率衡量指标的影响：每小时接诊患者人数（Pt/hr）和出院周转时间（TAT）。次要目标包括考察他们对非复苏患者急诊科吞吐量的影响：急诊科停留时间（LOS）、从门到医生的时间和未得到诊治离开率（LWBS）。
在这项回顾性研究中，我们评估了 2012 年 1 月 1 日至 2015 年 3 月 31 日期间在加拿大纽马克特社区医院急诊科工作的 6845 个临床班次，这些班次由 20 名急诊医师完成。采用聚类设计，我们按医师比较了有和没有医师导航员的班次之间的工作效率衡量指标。我们使用线性混合模型考察了使用医师导航员的急诊医师的 Pt/hr 和 TAT 出院的平均变化。对于次要目标，我们对非复苏患者实施医师导航员前后的急诊科吞吐量指标进行了自回归建模。
患者人数每天增加 20 人（p<0.001）。Pt/hr 平均增加 1.07 例/小时（0.98 至 1.16，p<0.001）。平均 TAT 出院时间减少 10.6 分钟（-13.2 至 -8.0，p<0.001）。实施医师导航员计划后，非复苏患者的总体平均 LOS 减少 2.6 分钟（p=0.007），平均门到医生时间减少 7.4 分钟（p<0.001）。LWBS 率从每日患者量的 1.13%降至 0.63%（p<0.001）。
尽管急诊科的工作量增加，但使用医师导航员与急诊医师工作效率的显著提高以及急诊科吞吐量时间的显著减少有关。
