What determines diagnostic resource consumption in emergency medicine: patients, physicians or context?

Hautz, Wolf E.; Sauter, Thomas C.; Hautz, Stefanie C.; Kämmer, Juliane E.; Schauber, Stefan K.; Birrenbach, Tanja; Exadaktylos, Aristomenis K.; Stock, Stephanie; Mûller, Martín

doi:10.1136/emermed-2019-209022

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…Patients with psychiatric problems should be carefully triaged, and specialists should be consulted at an early stage [ 2 ]. Our emergency centre is continuously committed to optimising processes based on resource analysis of specific patient populations [ 4 , 33 , 34 , 35 ]. This should continue in relation to the particularly vulnerable population of adolescent patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Presentations of Adolescents Aged 16–18 Years in the Adult Emergency Department

Brockhus

Bärtsch

Exadaktylos

et al. 2021

IJERPH

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Background: In many large hospitals in Switzerland, adolescents 16 years and older are treated in adult emergency departments (ED). There have been few publications about this specific patient population, especially in Switzerland. This study aims to provide an overview of emergency presentations of adolescents between 16–18 years of age when compared to adults and focuses on their principle complaints. Methods: We conducted a single-centre, retrospective, cross-sectional study of all patients aged 16 years and older presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from 2013 to 2017. This analysis gives an overview of emergency presentations of adolescents between 16–18 years of age in this time period and compares their consultation characteristics to those of adult patients. Results: Data of a total of 203,817 patients who presented to our adult ED between 2013 and 2017 were analysed. Adolescents account for 2.5% of all emergency presentations. The number of ED presentations in the reviewed time period rose for adults (+2368, 95% CI: 1695, 3041, p = 0.002 consultations more per year; +25% comparing 2013 with 2017), while adolescent presentations did not significantly increase (p = 0.420). In comparison to adult patients, adolescents presented significantly more often during the night (39.1% vs. 31.5%, p < 0.001), as walk-ins (54.2% vs. 44.9%, p < 0.001), or with less highly acute complaints at triage (21% vs. 31%, p < 0.001). They were more likely to be discharged (70.8% vs. 52.2%, p < 0.001). We found a significant association between the two age groups and principle complaints. In comparison to adults, trauma and psychiatric problems were significantly more common among adolescents. Conclusions: Our data showed that complaints in adolescent patients under 18 years of age significantly differ from those in older patients. The artificial age cut-off therefore puts this vulnerable population at risk of receiving inadequate diagnostic testing and treatment adapted only for adults. Additional studies are needed on the reasons adolescents and young adults seek ED care, as this could lead to improvements in the care processes for this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

Clinical Presentations of Adolescents Aged 16–18 Years in the Adult Emergency Department

Brockhus

Bärtsch

Exadaktylos

et al. 2021

IJERPH

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“…Finally, whereas we recently found that resource utilization is in large part dependent on the physicians’ ratings of case difficulty (i.e. their situational level of uncertainty, familiarity and perceived difficulty), we did not include these variables in our study, which focusses on data easily available early in the patient ED presentation [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

The development and validation of a resource consumption score of an emergency department consultation

et al. 2021

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Background Emergency Department (ED) visits and health care costs are increasing globally, but little is known about contributing factors of ED resource consumption. This study aims to analyse and to predict the total ED resource consumption out of the patient and consultation characteristics in order to execute performance analysis and evaluate quality improvements. Methods Characteristics of ED visits of a large Swiss university hospital were summarized according to acute patient condition factors (e.g. chief complaint, resuscitation bay use, vital parameter deviations), chronic patient conditions (e.g. age, comorbidities, drug intake), and contextual factors (e.g. night-time admission). Univariable and multivariable linear regression analyses were conducted with the total ED resource consumption as the dependent variable. Results In total, 164,729 visits were included in the analysis. Physician resources accounted for the largest proportion (54.8%), followed by radiology (19.2%), and laboratory work-up (16.2%). In the multivariable final model, chief complaint had the highest impact on the total ED resource consumption, followed by resuscitation bay use and admission by ambulance. The impact of age group was small. The multivariable final model was validated (R2 of 0.54) and a scoring system was derived out of the predictors. Conclusions More than half of the variation in total ED resource consumption can be predicted by our suggested model in the internal validation, but further studies are needed for external validation. The score developed can be used to calculate benchmarks of an ED and provides leaders in emergency care with a tool that allows them to evaluate resource decisions and to estimate effects of organizational changes.

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“…Total resource consumption is the result of a complex interplay between three main drivers: patient factors (e.g., age, comorbidity, clinical presentation, and patient expectations), physician factors (e.g., experience, level of training, risk tolerance, and tolerance of uncertainty), and contextual factors (e.g., crowding, wait-times, and accessibility of advanced diagnostics and therapeutics) [27][28][29]. Any intervention, and any subsequent evaluation, that focuses only on one part of this triad will inevitably leave unaccounted for the contributory impact of the other two drivers of utilization.…”

Section: Discussionmentioning

confidence: 99%

The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA)

Salehi

Jaskolka

et al. 2022

Emerg Radiol

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PurposeThe increased utilization, and potential overutilization, of computed tomography pulmonary angiography (CTPA) is a well-recognized issue within emergency departments (EDs). The objective of this study is to determine the impact of performance feedback reports on CTPA ordering behavior among ED physicians. Methods We conducted a prospective study of the impact of individualized performance feedback reports on the ordering behavior of physicians working at two high-volume community EDs in Ontario, Canada. We generated individualized reports (or "Dashboards") for each ED physician containing detailed feedback and peer comparison for each physician's CTPA ordering. Our baseline pre-intervention period was January 1 to December 31, 2018, and our intervention period was January 1, 2019, to December 31, 2021. We tracked individual and group ordering behavior through the study period. Our primary outcomes are impact of feedback on (1) overall group ordering rate and (2) overall diagnostic yield. Secondary analysis was done to determine the impact of the intervention on those physicians with the highest CTPA utilization rate. Results There was no statistically significant difference in the diagnostic yield of the included physicians in either of the years of the intervention period. There was a statically significant increase in the utilization rate for CTPA from 2018 to 2020 and 2021 from 5.9 to 7.9 and 11.4 CTPAs per 1000 ED visits respectively (p < 0.5). Conclusion Our study found no consistent significant impact of individualized feedback and peer comparison on physician ordering of CTPAs. This points to a potentially greater impact of environmental and institutional factors, as opposed to physician-targeted quality improvement measures, on physician ordering behavior.

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What determines diagnostic resource consumption in emergency medicine: patients, physicians or context?

Cited by 9 publications

References 24 publications

Clinical Presentations of Adolescents Aged 16–18 Years in the Adult Emergency Department

Clinical Presentations of Adolescents Aged 16–18 Years in the Adult Emergency Department

The development and validation of a resource consumption score of an emergency department consultation

The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA)

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