Abstract
Background
Emergency physicians differ in many ways with respect to practice. One area in which
interphysician practice differences are not well characterized is emergency department
(ED) length of stay (LOS).
Objective
To describe how ED LOS differs among physicians.
Methods
We performed a 3-year, five-ED retrospective study of non-fast-track visits evaluated
primarily by physicians. We report each provider's observed LOS, as well as each provider's
ratio of observed LOS/expected LOS (LOSO/E); we determined expected LOS based on site average adjusted for the patient characteristics
of age, gender, acuity, and disposition status, as well as the time characteristics
of shift, day of week, season, and calendar year.
Results
Three hundred twenty-seven thousand, seven hundred fifty-three visits seen by 92 physicians
were eligible for analysis. For the five sites, the average shortest observed LOS
was 151 min (range 106–184 min), and the average longest observed LOS was 232 min
(range 196–270 min); the average difference was 81 min (range 69–90 min). For LOSO/E, the average lowest LOSO/E was 0.801 (range 0.702–0.887), and the average highest LOSO/E was 1.210 (range 1.186–1.275); the average difference between the lowest LOSO/E and the highest LOSO/E was 0.409 (range 0.305–0.493).
Conclusion
There are significant differences in ED LOS at the level of the individual physician,
even after accounting for multiple confounders. We found that the LOSO/E for physicians with the lowest LOSO/E at each site averaged approximately 20% less than predicted, and that the LOSO/E for physicians with the highest LOSO/E at each site averaged approximately 20% more than predicted.
Keywords
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Article info
Publication history
Published online: February 14, 2018
Accepted:
December 17,
2017
Received in revised form:
November 27,
2017
Received:
April 8,
2017
Footnotes
Presented, in part, at the 2016 American College of Emergency Physician Research Forum, Las Vegas, NV.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
