Do billing codes accurately reflect pediatric emergency physician workload? A cross-sectional study.

Area of Science:

• Emergency Medicine
• Health Services Research

Background:

• Accurate measurement of physician workload in pediatric emergency departments (EDs) is crucial for optimizing staffing and improving patient flow.
• Currently, no universally accepted metric exists to quantify pediatric ED physician workload.
• Billing codes, reflecting treatment complexity, are explored as potential workload surrogates.

Purpose of the Study:

• To evaluate the validity of billing codes as a surrogate measure for physician workload in the pediatric emergency department.
• To determine if billing codes correlate with objective measures of physician work and visit complexity.

Main Methods:

• A retrospective health records review of 150 pediatric ED visits was conducted.
• Multivariable ordinal logistic regression models assessed associations between physician-assigned billing codes and measures of physician work.
• Sensitivity analysis included billing auditor-assigned codes.

Main Results:

• Physician-assigned billing codes showed associations with ordering labs, medications, and specialist consultations.
• No significant associations were found between billing codes and physician work measures after adjusting for visit complexity, age, and sex.
• Visit acuity (PaedsCTAS 1-3) was significantly associated with increased billing codes.

Conclusions:

• Limited evidence supports the content validity of billing codes as a surrogate for pediatric ED physician workload.
• The findings underscore the need for developing a dedicated, valid, and reliable workload measure for pediatric emergency physicians.
• Optimizing staffing and improving ED efficiency necessitates accurate workload assessment.