Individual emergency physician admission rates: predictably unpredictable

Area of Science:

• Emergency Medicine
• Healthcare Management
• Clinical Practice Variation

Background:

• Admission practices among emergency physicians (EPs) can vary.
• Understanding this variability is crucial for consistent patient care in emergency departments (EDs).
• The Canadian Emergency Department Triage Acuity Scale (CTAS) provides a standardized framework for patient acuity.

Purpose of the Study:

• To quantify the variability in admission practices among individual EPs within a single ED.
• To explore potential causes for this variability, including physician experience, demographics, and attitudes.
• To analyze admission patterns across different CTAS acuity levels.

Main Methods:

• A survey on attitudes and demographics was distributed to 30 EPs at a regional hospital.
• Hospital admission data for one year were linked to individual EP survey responses.
• EPs were categorized as lower, average, or higher admitters, and data were analyzed for correlations.

Main Results:

• EP admission rates ranged from 8.7% to 17.0% (mean 12.52%).
• Significant variability in admission rankings was observed across CTAS categories for individual EPs.
• More years of emergency medicine experience correlated with higher CTAS-2 admissions (r = 0.4, p < 0.05).

Conclusions:

• Substantial variability exists in individual EPs' overall and CTAS-specific admission rates.
• Physician experience is linked to higher CTAS-2 admission rates, but other factors like certification and attitudes were not significant predictors.
• EPs exhibit unique, individual admission ranking profiles across all CTAS categories.