Sherer Joseph, Caloia Roya, Corser William D, Tishkowski Kevin
ProMedica Monroe Regional Hospital, Emergency Medicine Residency Program.
Michigan State University College of Osteopathic Medicine, Statewide Campus System.
Spartan Med Res J. 2016 Oct 24;1(1):5065. doi: 10.51894/001c.5065.
Lacerations are a common occurrence in urgent care and emergency room settings. The types of lacerations repaired in these settings range from superficial and linear to deep and stellate. Healthcare professionals are required to describe these wounds in documentation and part of that description is length. In a busy clinical setting, many providers use a visual estimation of wound length for documentation. The purpose of this exploratory pilot study was to systematically examine the factors (e.g., sex, residency year, prior laceration training) associated with overall accuracy of five laceration length estimates made on a series of five identically-marked linear dummy torso sutured lacerations by a convenience sample of Emergency Medicine (EM) resident physicians. Before the study, the authors hypothesized that laceration estimates from later-year residents and/or those with more prior laceration training would be more accurate.
The EM residents who attended a statewide educational session were encouraged to participate in the study by independently entering information concerning their a) personal characteristics, and b) five laceration length estimates from five dummy torso sutured lacerations onto hard copy forms during break and lunch periods of the daylong conference. The use of any types of measurement devices was prohibited.
A total non-probability convenience sample of 107 participants (93 EM resident physicians and 14 medical student attendees) from 14 different Michigan-based EM residency programs completed a 10-item survey during the educational conference. Results for both composite and individual actual-to-estimated (AE) laceration differences varied widely within the sample, with up to 58.9% of laceration over estimates hypothetically having resulted in overbilling of payers for the laceration repair.
The considerable range in laceration estimates obtained from these EM clinicians indicate the complexity of attempting to estimate lacerations without measuring devices, as well as the potential for over-billing under such conditions. Larger resident samples recording laceration length estimates, with testing of potential interaction effects on AE patterns, are needed in the future to provide additional evidence concerning this aspect of EM billing.
裂伤在紧急护理和急诊室环境中很常见。在这些环境中修复的裂伤类型从浅表线性到深部星状不等。医疗保健专业人员需要在文档中描述这些伤口，其中一部分描述是长度。在繁忙的临床环境中，许多提供者使用对伤口长度的视觉估计进行文档记录。这项探索性试点研究的目的是系统地检查与急诊医学（EM）住院医师便利样本对一系列五个标记相同的线性假人躯干缝合裂伤进行的五次裂伤长度估计的总体准确性相关的因素（例如性别、住院年份、先前的裂伤培训）。在研究之前，作者假设来自后期住院医师和/或有更多先前裂伤培训的人的裂伤估计会更准确。
参加全州教育会议的EM住院医师被鼓励在为期一天的会议的休息和午餐时间，通过独立在硬拷贝表格上输入有关他们的a）个人特征，以及b）来自五个假人躯干缝合裂伤的五次裂伤长度估计的信息来参与研究。禁止使用任何类型的测量设备。
来自密歇根州14个不同EM住院医师培训项目的总共107名参与者（93名EM住院医师和14名医学学生参与者）的非概率便利样本在教育会议期间完成了一项10项调查。样本中综合和个体实际与估计（AE）裂伤差异的结果差异很大，假设高达58.9%的裂伤高估导致了裂伤修复向支付者的超额计费。
从这些EM临床医生获得的裂伤估计范围很大，这表明在没有测量设备的情况下试图估计裂伤的复杂性，以及在这种情况下超额计费的可能性。未来需要更大的住院医师样本记录裂伤长度估计，并测试对AE模式的潜在交互作用，以提供有关EM计费这一方面的更多证据。
