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Individual emergency physician admission rates: predictably unpredictable

Published online by Cambridge University Press:  21 May 2015

David Mutrie ,
S. Kathleen Bailey  and
Saleem Malik
David Mutrie*
Affiliation:
Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ont. Northern Ontario School of Medicine, Thunder Bay, Ont.
S. Kathleen Bailey
Affiliation:
Northern Ontario School of Medicine, Thunder Bay, Ont.
Saleem Malik
Affiliation:
Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ont. Northern Ontario School of Medicine, Thunder Bay, Ont.
*
980 Oliver Rd., Thunder Bay ON P7B 6V4; dmutrie@tbaytel.net

Abstract

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Objective:

We sought to determine the degree and possible causes of variability in admission practices among individual emergency physicians (EPs) at 1 emergency department (ED) using a Canadian Emergency Department Triage Acuity Scale (CTAS)–matched ED patient population.

Methods:

We distributed a survey measuring attitudes and demographics to all EPs (n = 30) at a large regional hospital. Hospital admissions data from 1 calendar year were matched to individual EP survey results. Emergency physicians were ranked as “lower,” “average” or “higher” admitters and, using these categorical variables, the data set was analyzed for correlations and trends.

Results:

Overall, 97.0% of the EPs responded to the survey. Admissions by EPs ranged from 8.7% to 17.0%, (mean 12.52, standard deviation [SD] 2.21) of all patients seen. CTAS category–specific admission data demonstrated variability in the admission ranking of individual EPs. No EPs consistently performed at any 1 admission ranking across all CTAS categories. More years of emergency medicine experience was significantly correlated with higher admissions in the CTAS-2 ranking (r = 0.4, p < 0.05). Whether a physician worked full-time, part-time or as a locum was not associated with patterns of admission, nor was any particular postgraduate certification (e.g., CCFP, CCFP EM, FRCPC) or any of the surveyed attitudinal traits.

Conclusion:

Individual EPs' overall and CTAS-specific admissions varied substantially, and followed an approximately normal distribution curve. Emergency physicians with more years of experience had a statistically higher CTAS-2 admission rate; however, other variables, including postgraduate certification status, decision-related attitudes toward admission, and reported practices were not associated with admission proportions. Emergency physicians tend to have uniquely individual admission ranking profiles across all the CTAS categories.

Keywords

emergency physician admission rates
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 2 , March 2009 , pp. 149 - 155
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

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