Abstract
Objective
The objective of this study was to determine specific provider practices associated with high provider efficiency in community emergency departments (EDs).
Methods
A mixed methods study design was utilized to identify key behaviors associated with efficiency:
Stage 1. A convenience sample of sixteen participants (ED medical directors, nurses, advanced practice providers, and physicians) identified provider efficiency behaviors during semi-structured interviews. Ninety-nine behaviors were identified and distilled by a group of three ED clinicians into 18 themes.
Stage 2. An observational study of 35 providers was performed in four (30,000 to 55,000-visit) community EDs during two 4-hour periods and recorded in minute-by-minute observation logs.
Stage 3. Each behavior or practice from Stage 1 was assigned a score within each observation period. Behaviors were tested for association with provider efficiency (Relative Value Units [RVUs] per hour) using linear univariate generalized estimating equations (GEE) with an identity link, clustered on ED site.
Results
Five ED provider practices were found to be positively associated with efficiency: average patient load, using name of team member, conversations with health care team, visits to patient rooms, and running the board. Two behaviors, "inefficiency practices", demonstrated significant negative correlations: non-work-related tasks and documentation on patients no longer in the ED.
Conclusions
Average patient load, running the board, conversations with team member, and using names of team members is associated with enhanced provider productivity. Identification of behaviors associated with efficiency can be utilized by medical directors, clinicians, and trainees to improve personal efficiency or counsel team members.
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from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yV8NsD
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