A comparison of resource utilization between emergency physicians and pediatric emergency physicians

Pediatric patients in the emergency department (ED) are typically seen either by general emergency physicians (EPs) or by pediatric emergency physicians (PEPs) who have completed either a fellowship in pediatric emergency medicine or both pediatric and emergency medicine residencies. This study evaluates admission rates, turnaround times, and test and medication utilization for EPs versus PEPs.

A retrospective chart analysis was conducted at an academic tertiary care hospital with a dedicated pediatric ED. When the pediatric ED is open (from noon to midnight), it is always staffed with dedicated pediatric nurses and residents. In our ED, the only variable is the attending physician, who can either be an EP or a PEP. All visits for patients younger than 18 years who presented during the time the pediatric ED was open from July 1, 2007, to June 30, 2010, were eligible for inclusion. Only patients seen by physicians who saw more than 400 patients during this period were included. Disposition outcomes for patients who were either admitted or discharged were compared between EPs and PEPs. Complete blood count, Chem 7, urinalysis, chest radiography ordering rates, and intravenous fluid and ondansetron administration were used as surrogates for general conclusions about test utilization.

There were 13,347 patient visits eligible for inclusion, of which 8330 (62.4%) were seen by 2 PEPs, and 5017 (37.6%) were seen by 9 EPs. There was a difference in mean patient age (6.9 vs 7.1 years, P = 0.01), whereas sex (53.6% vs 53.9% male, P = 0.72), race (P = 0.13), acuity (mean Emergency Severity Index 3.35 vs 3.33, P = 0.99), and mode of arrival (10.6% vs 12.3% emergency medical services transport, P = 0.06) were not significantly different. Overall admission rates were similar (17.1% PEP vs 17.5% EP, P = 0.50), as were critical care admissions (2.9% PEP vs 2.7% EP of total admissions, P = 0.40). Turnaround times were significantly different (146.0 ± 2.5 minutes PEP vs 149.7 ± 3.2 minutes EP, P = 0.04). Ordering rates of Chem 7, urinalyses, chest radiographs, and ondansetron were lower by PEPs.

In our pediatric ED, which represents a natural experiment where the type of physician is the only variable, PEPs and EPs have similar rates of admission to floor beds and critical care. Pediatric EPs are slightly faster at throughput and order fewer tests and medication.