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Multicenter Study
. 2022 Apr;17(3):829-837.
doi: 10.1007/s11739-021-02796-8. Epub 2021 Jul 22.

The presentations/physician ratio predicts door-to-physician time but not global length of stay in the emergency department: an Italian multicenter study during the SARS-CoV-2 pandemic

Simone Vanni  1 , Paola Bartalucci  2 , Ubaldo Gargano  2 , Alessandro Coppa  2 , Gianfranco Giannasi  3 , Peiman Nazerian  4 , Barbara Tonietti  5 , Roberto Vannini  6 , Michele Lanigra  7 , Fabio Daviddi  8 , Alessio Baldini  9 , Stefano Grifoni  4 , Simone Magazzini  9
Affiliations
Multicenter Study

The presentations/physician ratio predicts door-to-physician time but not global length of stay in the emergency department: an Italian multicenter study during the SARS-CoV-2 pandemic

Simone Vanni et al. Intern Emerg Med. 2022 Apr.

Abstract

To investigate the effects of the dramatic reduction in presentations to Italian Emergency Departments (EDs) on the main indicators of ED performance during the SARS-CoV-2 pandemic. From February to June 2020 we retrospectively measured the number of daily presentations normalized for the number of emergency physicians on duty (presentations/physician ratio), door-to-physician and door-to-final disposition (length-of-stay) times of seven EDs in the central area of Tuscany. Using the multivariate regression analysis we investigated the relationship between the aforesaid variables and patient-level (triage codes, age, admissions) or hospital-level factors (number of physician on duty, working surface area, academic vs. community hospital). We analyzed data from 105,271 patients. Over ten consecutive 14-day periods, the number of presentations dropped from 18,239 to 6132 (- 67%) and the proportion of patients visited in less than 60 min rose from 56 to 86%. The proportion of patients with a length-of-stay under 4 h decreased from 59 to 52%. The presentations/physician ratio was inversely related to the proportion of patients with a door-to-physician time under 60 min (slope - 2.91, 95% CI - 4.23 to - 1.59, R2 = 0.39). The proportion of patients with high-priority codes but not the presentations/physician ratio, was inversely related to the proportion of patients with a length-of-stay under 4 h (slope - 0.40, 95% CI - 0.24 to - 0.27, R2 = 0.36). The variability of door-to-physician time and global length-of-stay are predicted by different factors. For appropriate benchmarking among EDs, the use of performance indicators should consider specific, hospital-level and patient-level factors.

Keywords: Community hospital; Door-to-physician; Emergency Department; Length-of-stay; Performance indicator.

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Conflict of interest statement

The author(s) declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Presentations/physician ratio
Fig. 2
Fig. 2
Paients with triage code 1, 2 or 3 (%)
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References

    1. National Quality Forum National Voluntary Consensus Standards for Emergency Care. http://www.qualityforum.org/projects/ongoing/emergency/. (Accessed 22 June 2009).
    1. Wilper AP, Woolhandler S, Lasser KE, et al. Waits to see an emergency department physician: US trends and predictors, 1997–2004. Health Aff (Millwood) 2008;27:w84–95. doi: 10.1377/hlthaff.27.2.w84. - DOI - PubMed
    1. Horwitz LI, Green J, Bradley EH. US emergency department performance on wait time and lenght of visit. Ann Emerg Med. 2010;55:133–141. doi: 10.1016/j.annemergmed.2009.07.023. - DOI - PMC - PubMed
    1. Paling S, Lambert J, Clouting J, et al. Waiting times in emergency departments: exploring the factors associated with longer patient waits for emergency care in England using routinely collected daily data. Emerg Med J. 2020;37:781–786. - PMC - PubMed
    1. Welch SJ, Asplin BR, Stone-Griffith S, Davidson SJ, Augustine J, Schuur J. Emergency department benchmarking alliance. Emergency department operational metrics, measures and definitions: results of the second performance measures and benchmarking Summit. Ann Emerg Med. 2011;58:33–40. doi: 10.1016/j.annemergmed.2010.08.040. - DOI - PubMed

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