Journal article
Key High-efficiency Practices of Emergency Department Providers: A Mixed-methods Study
Academic emergency medicine, Vol.25(7), pp.795-803
07/2018
DOI: 10.1111/acem.13361
PMCID: PMC6005715
PMID: 29265539
Abstract
The objective of this study was to determine specific provider practices associated with high provider efficiency in community emergency departments (EDs).
A mixed-methods study design was utilized to identify key behaviors associated with efficiency. Stage 1 was a convenience sample of 16 participants (ED medical directors, nurses, advanced practice providers, and physicians) identified provider efficiency behaviors during semistructured interviews. Ninety-nine behaviors were identified and distilled by a group of three ED clinicians into 18 themes. Stage 2 was 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. In 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/hour) using linear univariate generalized estimating equations with an identity link, clustered on ED site.
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.
Average patient load, running the board, conversations with team member, and using names of team members are 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.
Details
- Title: Subtitle
- Key High-efficiency Practices of Emergency Department Providers: A Mixed-methods Study
- Creators
- Morgan R Bobb - University of Iowa Carver College of Medicine, Iowa City, IAAzeemuddin Ahmed - Department of Management and Organizations, University of Iowa Tippie College of Business, Iowa City, IAPaul Van Heukelom - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IARachel Tranter - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IAKarisa K Harland - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IABrady M Firth - Department of Management and Organizations, University of Iowa Tippie College of Business, Iowa City, IARandy Fry - Office of Operational Excellence, University of Iowa Hospitals and Clinics, Iowa City, IAKatherine Schneider - Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, IAKathryn K Dierks - Genesis Health Group, Davenport, IASarah L Miller - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IANicholas M Mohr - Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Academic emergency medicine, Vol.25(7), pp.795-803
- DOI
- 10.1111/acem.13361
- PMID
- 29265539
- PMCID
- PMC6005715
- NLM abbreviation
- Acad Emerg Med
- ISSN
- 1069-6563
- eISSN
- 1553-2712
- Publisher
- United States
- Grant note
- T35 HL007485 / NHLBI NIH HHS T32 GM007337 / NIGMS NIH HHS
- Language
- English
- Date published
- 07/2018
- Academic Unit
- Management and Entrepreneurship ; Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Law Faculty
- Record Identifier
- 9984024552102771
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