Not All Testers are Admitters: An Analysis of Emergency Physician Resource Utilization and Consultation Rates

Area of Science:

• Emergency Medicine
• Healthcare Operations Research
• Clinical Practice Patterns

Background:

• Significant variability exists in how emergency physicians (EPs) utilize resources, including diagnostic testing, consultations, and patient admission decisions.
• Previous research indicated a positive correlation between EP resource utilization and patient admission rates.

Purpose of the Study:

• To validate and expand upon existing data regarding the relationship between EP resource utilization and admission rates.
• To identify distinct subgroups of emergency physicians based on their ordering practices and resource utilization patterns.

Main Methods:

• A retrospective analysis of operational data from an urban academic tertiary care hospital's emergency department (ED).
• Individual EP data on advanced imaging, consultations, and admission rates per patient encounter were collected.
• A Gaussian mixture model was employed to classify EPs into distinct practice pattern groups.

Main Results:

• The study identified three distinct groups of EPs based on resource utilization: a large group with moderate utilization, a smaller group with low resource use, and a minimal group with high resource use.
• The largest group (37 EPs) showed moderate rates for advanced imaging (38.9%), consultations (45.1%), and admissions (39.3%).
• A low-resource group (15 EPs) and a high-resource group (6 EPs) were also identified, demonstrating practice variations.

Conclusions:

• Three distinct subgroups of emergency physician ordering practices, related to resource utilization and admission propensity, were identified at an academic tertiary center.
• These findings confirm the link between resource utilization and admission rates while revealing more complex practice variations among EPs.
• Further research is necessary to explore the influence of EP characteristics and behaviors on healthcare throughput and quality of care.