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The impact of implementing the single provider model of emergency medicine in a paediatric hospital: a retrospective cohort analysis
  1. Bradley J Crosby1,
  2. Francesco Mannelli2,
  3. Mladen Nisavic3,
  4. Alberto Passannante2,
  5. David M Cline4,
  6. Charles P Gillespie5,
  7. Antonio Messineo6,
  8. Kevin M Ban1,3
  1. 1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  2. 2Department of Pediatric Emergency Medicine, Anna Meyer Pediatric Hospital, University of Florence, Florence, Italy
  3. 3Harvard Medical School, Boston, Massachusetts, USA
  4. 4Department of Emergency Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
  5. 5Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA
  6. 6Department of Surgery, Anna Meyer Paediatric Hospital, University of Florence, Florence, Italy
  1. Correspondence to Dr Bradley J Crosby, Dixie Regional Medical Center, 1380 East Medical Center Drive, St. George, UT 84790, USA; brad.crosby{at}imail.org

Abstract

Study Objective The Meyer Pediatric Hospital in Florence, Italy recently implemented the single provider model of emergency medicine. Prior to these changes, patients were triaged to a paediatric surgeon or paediatrician based on the complaint. The authors assess the outcomes of patients evaluated by surgeons prior to this change and compare them with those of patients seen by emergency physicians.

Methods A retrospective, cohort study was performed reviewing patients seen in the emergency department between 2005 and 2008 for the three most common surgical complaints encountered before the systems change: head trauma, testicular pain and abdominal pain. Outcomes include misdiagnoses, consultation rates, dispositions, imaging, interventions and surgeries.

Results A total of 2415 patient visits were included. Emergency physicians saw more patients (1388 vs 1027) and obtained more consultations (25.6% vs 8.1%) than surgeons. Patients triaged directly to surgeons were more likely to be admitted to the hospital (10.3% vs 7.6%), undergo urgent interventions (9.5% vs 6.7%), undergo surgery (8.0% vs 4.8%), have more radiographic images to evaluate head trauma (12.1% vs 5.3%), be misdiagnosed (1.0% vs 0.3%) and have more plain films for abdominal pain (3.1% vs 1.3%). There is an overall trend towards fewer missed diagnoses by emergency physicians (0.3% vs 0.9%), but this difference is only statistically significant in the abdominal pain subset analysis (p=0.032, combined data p=0.052).

Conclusions The single provider model of emergency medicine where emergency physicians manage all patients presenting to the emergency department appears to be a safe and efficient model of emergency medical care.

  • Emergency department
  • ultrasound

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was granted by the institutional review board of University of Florence Careggi and Meyer Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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