Stephen J Traub1, Christopher F Stewart2, Roshanak Didehban2, Adam C Bartley3, Soroush Saghafian4, Vernon D Smith2, Scott M Silvers5, Ryan LeCheminant6, Christopher A Lipinski2. 1. Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN. Electronic address: Traub.Stephen@Mayo.edu. 2. Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN. 3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN. 4. College of Medicine, Mayo Clinic, Rochester, MN; School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ. 5. College of Medicine, Mayo Clinic, Rochester, MN; Department of Emergency Medicine, Mayo Clinic Florida, Jacksonville, FL. 6. Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ.
Abstract
STUDY OBJECTIVE: We compare emergency department (ED) operational metrics obtained in the first year of a rotational patient assignment system (in which patients are assigned to physicians automatically according to an algorithm) with those obtained in the last year of a traditional physician self-assignment system (in which physicians assigned themselves to patients at physician discretion). METHODS: This was a pre-post retrospective study of patients at a single ED with no financial incentives for physician productivity. Metrics of interest were length of stay; arrival-to-provider time; rates of left before being seen, left subsequent to being seen, early returns (within 72 hours), and early returns with admission; and complaint ratio. RESULTS: We analyzed 23,514 visits in the last year of physician self-assignment and 24,112 visits in the first year of rotational patient assignment. Rotational patient assignment was associated with the following improvements (percentage change): median length of stay 232 to 207 minutes (11%), median arrival to provider time 39 to 22 minutes (44%), left before being seen 0.73% to 0.36% (51%), and complaint ratio 9.0/1,000 to 5.4/1,000 (40%). There were no changes in left subsequent to being seen, early returns, or early returns with admission. CONCLUSION: In a single facility, the transition from physician self-assignment to rotational patient assignment was associated with improvement in a broad array of ED operational metrics. Rotational patient assignment may be a useful strategy in ED front-end process redesign.
STUDY OBJECTIVE: We compare emergency department (ED) operational metrics obtained in the first year of a rotational patient assignment system (in which patients are assigned to physicians automatically according to an algorithm) with those obtained in the last year of a traditional physician self-assignment system (in which physicians assigned themselves to patients at physician discretion). METHODS: This was a pre-post retrospective study of patients at a single ED with no financial incentives for physician productivity. Metrics of interest were length of stay; arrival-to-provider time; rates of left before being seen, left subsequent to being seen, early returns (within 72 hours), and early returns with admission; and complaint ratio. RESULTS: We analyzed 23,514 visits in the last year of physician self-assignment and 24,112 visits in the first year of rotational patient assignment. Rotational patient assignment was associated with the following improvements (percentage change): median length of stay 232 to 207 minutes (11%), median arrival to provider time 39 to 22 minutes (44%), left before being seen 0.73% to 0.36% (51%), and complaint ratio 9.0/1,000 to 5.4/1,000 (40%). There were no changes in left subsequent to being seen, early returns, or early returns with admission. CONCLUSION: In a single facility, the transition from physician self-assignment to rotational patient assignment was associated with improvement in a broad array of ED operational metrics. Rotational patient assignment may be a useful strategy in ED front-end process redesign.
Authors: Christian Rosenow; Sophia Aguirre; Thomas Polveroni; Zachary Ginsberg; Jordan Pollock; Stephen Traub; Douglas Rappaport Journal: Arch Acad Emerg Med Date: 2022-04-30
Authors: Xiaomei Wang; H Joseph Blumenthal; Daniel Hoffman; Natalie Benda; Tracy Kim; Shawna Perry; Ella S Franklin; Emilie M Roth; A Zachary Hettinger; Ann M Bisantz Journal: Int J Med Inform Date: 2021-04-09 Impact factor: 4.730
Authors: Bryan Imhoff; Kenneth D Marshall; Joshua W Joseph; Nima Sarani; Julie Kelman; Niaman Nazir Journal: J Am Coll Emerg Physicians Open Date: 2022-07-30