Key High‐efficiency Practices of Emergency Department Providers: A Mixed‐methods Study |
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| Authors: | Morgan R. Bobb Azeemuddin Ahmed MD MBA Paul Van Heukelom MD Rachel Tranter MPAS PA‐C Karisa K. Harland PhD MPH Brady M. Firth PhD MA Randy Fry MBA Katherine Schneider MSN RN CEN Kathryn K. Dierks DO Sarah L. Miller MD Nicholas M. Mohr MD MS |
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| Affiliation: | 1. University of Iowa Carver College of Medicine, Iowa City, IA;2. Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA;3. Department of Management and Organizations, University of Iowa Tippie College of Business, Iowa City, IA;4. Office of Operational Excellence, University of Iowa Hospitals and Clinics, Iowa City, IA;5. Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA;6. Genesis Health Group, Davenport, IA;7. Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine, Iowa City, IA |
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| Abstract: | Objective The objective of this study was to determine specific provider practices associated with high provider efficiency in community emergency departments (EDs). Methods A mixed‐methods study design was utilized to identify key behaviors associated with efficiency. Stage 1 was a convenience sample of 16 participants (ED medical directors, nurses, advanced practice providers, and physicians) identified provider efficiency behaviors during semistructured interviews. Ninety‐nine behaviors were identified and distilled by a group of three ED clinicians into 18 themes. Stage 2 was an observational study of 35 providers was performed in four (30,000‐ to 55,000‐visit) community EDs during two 4‐hour periods and recorded in minute‐by‐minute observation logs. In Stage 3, each behavior or practice from Stage 1 was assigned a score within each observation period. Behaviors were tested for association with provider efficiency (relative value units/hour) using linear univariate generalized estimating equations with an identity link, clustered on ED site. Results Five ED provider practices were found to be positively associated with efficiency: average patient load, using name of team member, conversations with health care team, visits to patient rooms, and running the board. Two behaviors, “inefficiency practices,” demonstrated significant negative correlations: non–work‐related tasks and documentation on patients no longer in the ED. Conclusions Average patient load, running the board, conversations with team member, and using names of team members are associated with enhanced provider productivity. Identification of behaviors associated with efficiency can be utilized by medical directors, clinicians, and trainees to improve personal efficiency or counsel team members. |
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