Observational studyEmergency medicine journal : EMJ2020
What determines diagnostic resource consumption in emergency medicine: patients, physicians or context?
Observational study in Emergency medicine journal : EMJ, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- A Retrospective Descriptive Analysis of Consultations Provided by the National Poisons Centre Relating to Medicines on the Aotearoa New Zealand Antidote Stocking Guideline, 2020-2025.Emergency medicine Australasia : EMA · 2026Article
- Emergency department utilisation and treatment for trauma-related presentations of adolescents aged 16-18: a retrospective cross-sectional study.BMC emergency medicine · 2024Article
- Article
- The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA).Emergency radiology · 2023Article
- Frequency and predictors of unspecific medical diagnoses in the emergency department: a prospective observational study.BMC emergency medicine · 2022Observational
- What factors affect team members' evaluation of collaboration in medical teams?Frontiers in psychology · 2022Article
- Clinical Presentations of Adolescents Aged 16-18 Years in the Adult Emergency Department.International journal of environmental research and public health · 2021Review
- The development and validation of a resource consumption score of an emergency department consultation.PloS one · 2021Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesA major cause for concern about increasing ED visits is that ED care is expensive. Recent research suggests that ED resource consumption is affected by patients' health status, varies between physicians and is context dependent. The aim of this study is to determine the relative proportion of characteristics of the patient, the physician and the context that contribute to ED resource consumption.
methodsData on patients, physicians and the context were obtained in a prospective observational cohort study of patients hospitalised to an internal medicine ward through the ED of the University Hospital Bern, Switzerland, between August and December 2015. Diagnostic resource consumption in the ED was modelled through a multilevel mixed effects linear regression.
resultsIn total, 473 eligible patients seen by one of 38 physicians were included in the study. Diagnostic resource consumption heavily depends on physicians' ratings of case difficulty (p<0.001, z-standardised regression coefficient: 147.5, 95% CI 87.3 to 207.7) and-less surprising-on patients' acuity (p<0.001, 126.0, 95% CI 65.5 to 186.6). Neither the physician per se, nor their experience, the patients' chronic health status or the context seems to have a measurable impact (all p>0.05).
conclusionsDiagnostic resource consumption in the ED is heavily affected by physicians' situational confidence. Whether we should aim at altering physician confidence ultimately depends on its calibration with accuracy.
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