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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.
Intern Emerg Med. 2021 Jul 22 [Online ahead of print]IE

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.

Authors+Show Affiliations

Emergency Medicine Unit, Ospedale San Giuseppe, Emergency Department of Azienda USL Toscana Centro, Empoli, Italy. simone2.vanni@uslcentro.toscana.it.Emergency Medicine Unit, Ospedale San Giuseppe, Emergency Department of Azienda USL Toscana Centro, Empoli, Italy.Emergency Medicine Unit, Ospedale San Giuseppe, Emergency Department of Azienda USL Toscana Centro, Empoli, Italy.Emergency Medicine Unit, Ospedale San Giuseppe, Emergency Department of Azienda USL Toscana Centro, Empoli, Italy.Emergency Medicine Unit, Ospedale San Giovanni di Dio, Emergency Department of Azienda USL Toscana Centro, Firenze, Italy.Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.Department of Health and Management, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.Emergency Medicine Unit, Ospedale del Mugello, Emergency Department of Azienda USL Toscana Centro, Borgo San Lorenzo, Italy.Emergency Medicine Unit, Ospedale Santa Maria Nuova, Emergency Department of Azienda USL Toscana Centro, Firenze, Italy.Emergency Medicine Unit, Ospedale Santi Cosa e Damiano, Emergency Department of Azienda USL Toscana Centro, Pescia, Italy.Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department of Azienda USL Toscana Centro, Prato, Italy.Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department of Azienda USL Toscana Centro, Prato, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34292458

Citation

Vanni, Simone, et al. "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." Internal and Emergency Medicine, 2021.
Vanni S, Bartalucci P, Gargano U, et al. 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. Intern Emerg Med. 2021.
Vanni, S., Bartalucci, P., Gargano, U., Coppa, A., Giannasi, G., Nazerian, P., Tonietti, B., Vannini, R., Lanigra, M., Daviddi, F., Baldini, A., Grifoni, S., & Magazzini, S. (2021). 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. Internal and Emergency Medicine. https://doi.org/10.1007/s11739-021-02796-8
Vanni S, et al. 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. Intern Emerg Med. 2021 Jul 22; PubMed PMID: 34292458.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Vanni,Simone, AU - Bartalucci,Paola, AU - Gargano,Ubaldo, AU - Coppa,Alessandro, AU - Giannasi,Gianfranco, AU - Nazerian,Peiman, AU - Tonietti,Barbara, AU - Vannini,Roberto, AU - Lanigra,Michele, AU - Daviddi,Fabio, AU - Baldini,Alessio, AU - Grifoni,Stefano, AU - Magazzini,Simone, Y1 - 2021/07/22/ PY - 2021/01/25/received PY - 2021/06/14/accepted PY - 2021/7/22/entrez PY - 2021/7/23/pubmed PY - 2021/7/23/medline KW - Community hospital KW - Door-to-physician KW - Emergency Department KW - Length-of-stay KW - Performance indicator JF - Internal and emergency medicine JO - Intern Emerg Med N2 - 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. SN - 1970-9366 UR - https://www.unboundmedicine.com/medline/citation/34292458/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. L2 - https://dx.doi.org/10.1007/s11739-021-02796-8 DB - PRIME DP - Unbound Medicine ER -
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