Simon Erin L, Smalley Courtney M, Meldon Stephen W, Borden Bradford L, Briskin Isaac, Muir McKinsey R, Suchan Andrew, Delgado Fernando, Fertel Baruch S
Department of Emergency Medicine Cleveland Clinic Akron General Akron Ohio USA.
Northeast Ohio Medical University Rootstown Ohio USA.
J Am Coll Emerg Physicians Open. 2020 Sep 26;1(6):1669-1675. doi: 10.1002/emp2.12238. eCollection 2020 Dec.
Emergency physicians must maintain procedural skills, but clinical opportunities may be insufficient. We sought to determine how often practicing emergency physicians in academic, community and freestanding emergency departments (EDs) perform 4 procedures: central venous catheterization (CVC), tube thoracostomy, tracheal intubation, and lumbar puncture (LP).
This was a retrospective study evaluating emergency physician procedural performance over a 12-month period. We collected data from the electronic records of 18 EDs in one healthcare system. The study EDs included higher and lower volume, academic, community and freestanding, and trauma and non-trauma centers. The main outcome measures were median number of procedures performed. We examined differences in procedural performance by physician years in practice, facility type, and trauma status.
Over 12 months, 182 emergency physicians performed 1582 of 2805 procedures (56%) and supervised (resident, nurse practitioner or physician assistant) an additional 1223 of the procedures they did not perform (43%). Median (interquartile range) physician performance for each procedure was CVC 0 [0, 2], tube thoracostomy 0 [0, 0], tracheal intubation 3 [0.25, 8], and LP 0 [0, 2]. The percentage of emergency physicians who did not perform at least one of each procedure during the 1-year time frame ranged from 25.3% (tracheal intubation) to 76.4% (tube thoracostomy). Physicians who work at high-volume EDs (>50,000 visits per year) performed nearly twice as many tracheal intubations, CVCs, and LPs than those at low-volume EDs or freestanding EDs when normalized per 1000 visits. Years out of training were inversely related to total number of procedures performed. Emergency physicians at trauma centers performed almost 3 times as many tracheal intubations and almost 4 times as many CVCs compared to non-trauma centers.
In a large healthcare system, regardless of ED type, emergency physicians infrequently performed the 4 procedures studied. Physicians in high-volume EDs, trauma centers, and recent graduates performed more procedures. Our study adds to a growing body of research that suggests clinical frequency alone may be insufficient for all emergency physicians to maintain competency.
急诊医生必须保持操作技能，但临床实践机会可能不足。我们试图确定在学术性、社区性和独立急诊部门工作的执业急诊医生执行4种操作的频率：中心静脉置管（CVC）、胸腔闭式引流术、气管插管和腰椎穿刺（LP）。
这是一项回顾性研究，评估了12个月期间急诊医生的操作表现。我们从一个医疗系统的18个急诊部门的电子记录中收集数据。研究中的急诊部门包括高流量和低流量、学术性、社区性和独立的，以及创伤和非创伤中心。主要结局指标是操作执行的中位数。我们按医生的执业年限、机构类型和创伤状况检查了操作表现的差异。
在12个月期间，182名急诊医生执行了2805项操作中的1582项（56%），并监督（住院医师、执业护士或医师助理）了他们未执行的另外1223项操作（43%）。每种操作的医生表现中位数（四分位间距）为：CVC 0[0, 2]，胸腔闭式引流术0[0, 0]，气管插管3[0.25, 8]，LP 0[0, 2]。在1年时间内未执行至少一项每种操作的急诊医生比例从25.3%（气管插管）到76.4%（胸腔闭式引流术）不等。在高流量急诊部门（每年就诊>50,000人次）工作的医生，按每1000人次就诊计算，其气管插管、CVC和LP的执行次数几乎是低流量急诊部门或独立急诊部门医生的两倍。培训结束后的年限与执行的操作总数呈负相关。与非创伤中心相比，创伤中心的急诊医生气管插管执行次数几乎多3倍，CVC执行次数几乎多4倍。
在一个大型医疗系统中，无论急诊部门类型如何，急诊医生很少执行所研究的4种操作。高流量急诊部门、创伤中心的医生以及刚毕业的医生执行的操作更多。我们的研究增加了越来越多的研究证据，表明仅靠临床操作频率可能不足以让所有急诊医生维持能力。
