Crowder Kathryn, Domm Elizabeth, Lipp Rachel, Robinson Owen, Vatanpour Shabnam, Wang Dongmei, Lang Eddy
Department of Emergency Medicine, Alberta Health Services, Calgary, AB, Canada.
University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
CJEM. 2023 Mar;25(3):224-232. doi: 10.1007/s43678-023-00459-5. Epub 2023 Feb 15.
Emergency department (ED) flow impacts patient safety, quality of care and ED provider satisfaction. Throughput interventions have been shown to improve flow, yet few studies have reported the impact of ED physician leadership roles on patient flow and provider experiences. The study objective was to evaluate the impacts of the emergency physician lead role on ED flow metrics and provider experiences.
Quantitative data about patient flow metrics were collected from ED information systems in two tertiary hospital EDs and analyzed to compare ED length of stay, EMS hallway length of stay, physician initial assessment time, 72-h readmission and left without being seen rates three months before and following emergency physician lead role implementation. ED flow metrics for adult patients at each site were analyzed independently using descriptive and inferential statistics, t tests and multivariable regression analysis. Qualitative data were collected via surveys from ED providers (physicians, nurses, and EMS) about their experiences working with the emergency physician leads and analyzed for themes about emergency physician leads impact.
The number of ED visits was relatively stable pre-post at the Peter Lougheed Centre (Lougheed) but increased pre-post at the Foothills Medical Centre (Foothills). Post-intervention at Lougheed median ED length of stay decreased by 18 min (p < 0.001) and at Foothills ED length of stay increased by 8 min (p < 0.001). EMS length of stay at Lougheed decreased by 20 min (p < 0.001), and at Foothills length of stay increased by 17 min (p < 0.001). Themes in provider feedback were that emergency physician leads (1) facilitated patient flow, (2) impacted provider workload, and (3) supported patient flow and safety with early assessments, treatments and investigations.
In this study, the emergency physician lead impacted ED flow metrics variably at different sites, but important learnings from provider experiences can guide future emergency physician lead implementation.
急诊科（ED）的流程会影响患者安全、护理质量以及急诊科医护人员的满意度。已证实吞吐量干预措施可改善流程，但很少有研究报告急诊科医生领导角色对患者流程和医护人员体验的影响。本研究的目的是评估急诊医生领导角色对急诊科流程指标和医护人员体验的影响。
从两家三级医院急诊科的急诊信息系统中收集有关患者流程指标的定量数据，并进行分析，以比较实施急诊医生领导角色前后三个月的急诊科住院时间、急救医疗服务（EMS）在走廊的停留时间、医生初始评估时间、72小时再入院率和未就诊离开率。使用描述性和推断性统计、t检验和多变量回归分析，对每个地点成年患者的急诊科流程指标进行独立分析。通过对急诊科医护人员（医生、护士和急救医疗服务人员）进行调查，收集关于他们与急诊医生领导合作经历的定性数据，并分析有关急诊医生领导影响的主题。
彼得·洛希德中心（洛希德）急诊科就诊人数在干预前后相对稳定，但山麓医疗中心（山麓）的就诊人数在干预前后有所增加。干预后，洛希德急诊科的中位住院时间减少了18分钟（p<0.001），而山麓急诊科的住院时间增加了8分钟（p<0.001）。洛希德的急救医疗服务停留时间减少了20分钟（p<0.001），而山麓的停留时间增加了17分钟（p<0.001）。医护人员反馈的主题是，急诊医生领导（1）促进了患者流程，（2）影响了医护人员的工作量，（3）通过早期评估、治疗和检查支持了患者流程和安全。
在本研究中，急诊医生领导在不同地点对急诊科流程指标的影响各不相同，但从医护人员体验中获得的重要经验教训可为未来急诊医生领导角色的实施提供指导。
