为急诊科住院医师提供个性化的吞吐量指标报告:对处置时间和住院医师看法的影响

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES AEM Education and Training Pub Date : 2024-06-18 DOI:10.1002/aet2.11007
Brent A. Becker MD, Andrew J. Bleinberger MD, Brandon J. Golden MD, Amber S. Billet MD
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引用次数: 0

摘要

研究背景 研究表明,定量指标报告可以提高急诊医生的临床表现;但是,很少有研究对培训中的医生的效果进行检查。研究的主要目的是评估为急诊医学(EM)住院医生提供个性化吞吐量指标对急诊科(ED)处置时间的影响。 方法 我们在 2021 年 1 月至 2022 年 12 月期间进行了一项单中心、回顾性、观察性研究,检查了为高年级急诊科住院医师提供个性化吞吐量指标前后的急诊科处置时间。住院医师每月都会收到前 6 个月平均的三个特定指标报告:(1)从病房到出院单的中位时间(Rm2Dc);(2)从返回所有结果到出院单的中位时间(Rlts2Dc);(3)从病房到住院会诊单的中位时间(Rm2Hosp)。通过独立 t 检验比较了指标共享前和共享期间三个指标的总体平均值,并按培训水平和时间进行了分层。为控制研究期间的时间差异,进行了调整分析。检验的显著性水平为 α = 0.05。 结果 共有 35 位居民参与了分析。总体而言,报告指标之前和期间的平均处置时间没有明显差异:Rm2Dc(154.8 分钟 vs. 148.9 分钟,p = 0.109)、Rslt2Dc(46.5 分钟 vs. 45.1 分钟,p = 0.522)和 Rm2Hosp(141.7 分钟 vs. 135.7 分钟,p = 0.257)。分组分析结果相似,但研究生三年级(PGY-3)组的平均 Rm2Hosp 显著下降(145.8 分钟对 124.1 分钟,p = 0.004)。调整后的平均值分析结果与未调整数据的结果相似。 结论 总体而言,个性化吞吐量指标与高年级急诊科住院医师急诊室处置平均时间的缩短无关;但是,在由 PGY-3 级住院医师诊治的住院患者子集中,我们观察到会诊平均时间缩短了 21.7 分钟。
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Individualized throughput metric reports for emergency medicine residents: Impact on time to disposition and resident perceptions

Background

Research suggests that quantitative metric reports can improve the clinical performance of emergency physicians; however, few studies have examined their effects on physicians in training. The primary study objective was to assess the effects of providing emergency medicine (EM) residents with individualized throughput metrics with regard to emergency department (ED) disposition times.

Methods

We performed a single-center, retrospective, observational study from January 2021 to December 2022 examining ED disposition times before and after providing upper-level EM residents individualized throughput metrics. Residents received monthly reports of three specific metrics averaged over the preceding 6 months: (1) median time from room to discharge order (Rm2Dc), (2) median time from return of all results to discharge order (Rlts2Dc), and (3) median time from room and to consult order for hospitalization (Rm2Hosp). Overall mean values of the three metrics before and during metric sharing were compared via independent t-test and stratified by level of training and time of year. Adjusted analysis was performed to control for temporal differences between study periods. Testing was conducted at α = 0.05 level of significance.

Results

A total of 35 unique residents were included in the analysis. Overall, mean disposition times were not significantly different before and during reporting of metrics: Rm2Dc (154.8 min vs. 148.9 min, p = 0.109), Rslt2Dc (46.5 min vs. 45.1 min, p = 0.522), and Rm2Hosp (141.7 min vs. 135.7 min, p = 0.257). Subgroup analysis yielded similar results, aside from a significant decrease in mean Rm2Hosp in the postgraduate year-3 (PGY-3) group (145.8 min vs. 124.1 min, p = 0.004). Analysis with adjusted means yielded results similar to those observed with unadjusted data.

Conclusions

Overall, individualized throughput metrics were not correlated with decreased average times to ED disposition for upper-level EM residents; however, in the subset of hospitalized patients seen by PGY-3 residents, we observed a mean decrease of 21.7 min to consultation.

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来源期刊
AEM Education and Training
AEM Education and Training Nursing-Emergency Nursing
CiteScore
2.60
自引率
22.20%
发文量
89
期刊最新文献
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