J Clin Outcomes Manage
Reducing patient retriage and improving physician attitudes by provision of consensus workup guidelines in the emergency department
Gleeson SK, O'Mahony SP, Berman L, Carius M, Kulaga ME, Tkacs DJ, Van Buskirk P, Wang Y, Fine J
Abstract Objective: To implement a quality improvement project that entailed explicit detailing of internal medicine expectations of emergency medicine (EM) physicians’ evaluations for major diagnoses in order to reduce retriages and improve relationships between EM physicians and internal medicine residents and hospitalists. Design: Pre/postintervention study. Setting: Community teaching hospital. Participants: EM physicians, medical residents, and hospitalists. Measurements: An electronic audit tool was created that allowed residents to record whether agreed-upon tests for individual patients were being checked by the EM physicians prior to admission. Retriage rates and attitude survey results before and after interventions were compared. Results: During the baseline period, EM physicians whose workups were judged satisfactorily complete in ? 89% of the audited cases had no cases retriaged in the audited sample. Following the interventions, the overall complete workup rate rose from baseline of 89% ± 11% to 94% ± 5% (P < 0.01) and the retriage rate fell from 5.2% to 1.5% (P = 0.02) of all cases recorded in the resident audits. However, the surveys at the end of the project failed to reveal an improvement in perceived behaviors of the physicians. Conclusion: Explicit evaluation guidelines can lead to more efficient management but are inadequate for improving relationships between EM and internal medicine physicians.
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