Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ, United States; College of Medicine, Mayo Clinic, Rochester, MN, United States.
Harvard Kennedy School, Cambridge, MA, United States.
Am J Emerg Med. 2018 Aug;36(8):1367-1371. doi: 10.1016/j.ajem.2017.12.045. Epub 2017 Dec 20.
Previous work has suggested that Emergency Department rotational patient assignment (a system in which patients are algorithmically assigned to physicians) is associated with immediate (first-year) improvements in operational metrics. We sought to determine if these improvements persisted over a longer follow-up period.
Single-site, retrospective analysis focused on years 2-4 post-implementation (follow-up) of a rotational patient assignment system. We compared operational data for these years with previously published data from the last year of physician self-assignment and the first year of rotational patient assignment. We report data for patient characteristics, departmental characteristics and facility characteristics, as well as outcomes of length of stay (LOS), arrival to provider time (APT), and rate of patients who left before being seen (LBBS).
There were 140,673 patient visits during the five year period; 138,501 (98.7%) were eligible for analysis. LOS, APT, and LBBS during follow-up remained improved vs. physician self-assignment, with improvements similar to those noted in the first year of implementation. Compared with the last year of physician self-assignment, approximate yearly average improvements during follow-up were a decrease in median LOS of 18min (8% improvement), a decrease in median APT of 21min (54% improvement), and a decrease in LBBS of 0.69% (72% improvement).
In a single facility study, rotational patient assignment was associated with sustained operational improvements several years after implementation. These findings provide further evidence that rotational patient assignment is a viable strategy in front-end process redesign.
先前的研究表明，急诊科轮转患者分配（一种根据算法将患者分配给医生的系统）与运营指标的即时（第一年）改善有关。我们试图确定这些改进是否在更长的随访期间持续存在。
单站点、回顾性分析集中在轮转患者分配系统实施后的第 2-4 年（随访）。我们将这些年份的运营数据与之前公布的最后一年医生自我分配和轮转患者分配第一年的数据进行了比较。我们报告了患者特征、科室特征和设施特征的数据，以及住院时间（LOS）、到达提供者时间（APT）和在未接受治疗前离开的患者比例（LBBS）的结果。
在五年期间，共有 140673 名患者就诊；其中 138501 名（98.7%）符合分析条件。与医生自我分配相比，随访期间的 LOS、APT 和 LBBS 仍然有所改善，且改善情况与实施第一年相似。与医生自我分配的最后一年相比，随访期间每年的平均改善情况为：中位数 LOS 缩短 18 分钟（改善 8%），中位数 APT 缩短 21 分钟（改善 54%），LBBS 降低 0.69%（改善 72%）。
在一项单一机构研究中，轮转患者分配与实施后数年的持续运营改进相关。这些发现进一步证明了轮转患者分配是前端流程重新设计的可行策略。
