Objectives We created Physician Navigators in our ED to help improve emergency physician (EP) productivity. We aimed to quantify the effect of Physician Navigators on measures of EP productivity: patient seen per hour (Pt/hr), and turn-around time (TAT) to discharge. Secondary objectives included examining their impact on measures of ED throughput for non-resuscitative patients: ED length of stay (LOS), door-to-physician time and left-without-being-seen rates (LWBS).
Methods In this retrospective study, 6845 clinical shifts worked by 20 EPs at a community ED in Newmarket, Canada from 1 January 2012 to 31 March 2015 were evaluated. Using a clustered design, we compared productivity measures between shifts with and without Physician Navigators, by physician. We used a linear mixed model to examine mean changes in Pt/hr and TAT to discharge for EPs who employed Physician Navigators. For secondary objectives, autoregressive modelling was performed to compare ED throughput metrics before and after the implementation of Physician Navigators for non-resuscitative patients.
Results Patient volumes increased by 20 patients per day (p<0.001). Mean Pt/hr increased by 1.07 patients per hour (0.98 to 1.16, p<0.001). The mean TAT to discharge decreased by 10.6 min (−13.2 to −8.0, p<0.001). After implementation of the Physician Navigator programme, overall mean LOS for non-resuscitative patients decreased by 2.6 min (p=0.007), and mean door-to-physician time decreased by 7.4 min (p<0.001). LBWS rates decreased from 1.13% to 0.63% of daily patient volume (p<0.001).
Conclusion Despite an ED volume increase, the use of a Physician Navigator was associated with significant improvements in EP productivity, and significant reductions in ED throughput times.
- emergency department operations
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Contributors All authors listed have contributed sufficiently to the project to be included as authors. AKL, GP, EC and MD had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. AKL, GP, EC and MD were responsible for study concept and design. AKL, GP, BEC, ZG, EC, EF and MD were involved in the acquisition, analysis or interpretation of data, drafting of the manuscript and critical revision of the manuscript for important intellectual content.
Competing interests MD is the founder of the Physician Navigator programme at Southlake. MD did not receive any funding or compensation for his role in the creation of the Physician Navigator programme, and was not compensated for his contributions to this work. The Physician Navigator programme did not provide any funding support for this work. EF was hired as a Physician Navigator in 2016. He was not a Physician Navigator during the study period, and was not compensated for his contributions to this work. The other authors have no conflicts to disclose.
Ethics approval Southlake Regional Health Centre Research Ethics Board.
Provenance and peer review Not commissioned; externally peer reviewed.
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