■研究表明,定量指标报告可以改善急诊医生的临床表现;然而,很少有研究检查它们对医生培训的影响。主要研究目标是评估为急诊医学(EM)居民提供有关急诊科(ED)处置时间的个性化吞吐量指标的效果。
■我们执行了单中心,回顾性,2021年1月至2022年12月的观察性研究,研究提供上层EM居民个性化吞吐量指标之前和之后的ED处置时间。居民收到了前6个月平均三个特定指标的月度报告:(1)从房间到出院顺序的中位时间(Rm2Dc),(2)从所有结果返回到出院顺序的中位时间(Rlts2Dc),(3)从房间到住院的中位时间(Rm2Hosp)。通过独立t检验比较指标共享之前和期间三个指标的总体平均值,并按培训水平和一年中的时间进行分层。进行调整分析以控制研究期间之间的时间差异。在α=0.05显著性水平下进行测试。
■共有35名独特居民被纳入分析。总的来说,在报告指标之前和期间,平均处置时间没有显着差异:Rm2Dc(154.8分钟与148.9分钟,p=0.109),Rslt2Dc(46.5分钟vs.45.1分钟,p=0.522),和Rm2Hosp(141.7分钟vs.135.7分钟,p=0.257)。亚组分析产生了类似的结果,除了研究生3年级(PGY-3)组的平均Rm2Hosp显着下降(145.8分钟vs.124.1分钟,p=0.004)。用调整的平均值分析产生与用未调整的数据观察到的结果相似的结果。
■总的来说,个性化吞吐量指标与上层EM居民平均ED处置时间的减少无关;然而,在PGY-3居民看到的住院患者中,我们观察到咨询时间平均减少21.7分钟。
UNASSIGNED: Research suggests that quantitative metric
reports can improve the clinical performance of emergency physicians; however, few studies have examined their effects on physicians in training. The primary study objective was to assess the effects of providing emergency medicine (EM) residents with individualized throughput metrics with regard to emergency department (ED) disposition times.
UNASSIGNED: We performed a single-center, retrospective, observational study from January 2021 to December 2022 examining ED disposition times before and after providing upper-level EM residents individualized throughput metrics. Residents received monthly
reports of three specific metrics averaged over the preceding 6 months: (1) median time from room to discharge order (Rm2Dc), (2) median time from return of all results to discharge order (Rlts2Dc), and (3) median time from room and to consult order for hospitalization (Rm2Hosp). Overall mean values of the three metrics before and during metric sharing were compared via independent t-test and stratified by level of training and time of year. Adjusted analysis was performed to control for temporal differences between study periods. Testing was conducted at α = 0.05 level of significance.
UNASSIGNED: A total of 35 unique residents were included in the analysis. Overall, mean disposition times were not significantly different before and during reporting of metrics: Rm2Dc (154.8 min vs. 148.9 min, p = 0.109), Rslt2Dc (46.5 min vs. 45.1 min, p = 0.522), and Rm2Hosp (141.7 min vs. 135.7 min, p = 0.257). Subgroup analysis yielded similar results, aside from a significant decrease in mean Rm2Hosp in the postgraduate year-3 (PGY-3) group (145.8 min vs. 124.1 min, p = 0.004). Analysis with adjusted means yielded results similar to those observed with unadjusted data.
UNASSIGNED: Overall, individualized throughput metrics were not correlated with decreased average times to ED disposition for upper-level EM residents; however, in the subset of hospitalized patients seen by PGY-3 residents, we observed a mean decrease of 21.7 min to consultation.