Practice Variation and Effects of E-mail-only Performance Feedback on Resource Use in the Emergency Department
| Autor: | Carmen Coombs, Ann Thompson, Brandon Ayers, Jong H Jeong, Robert W. Hickey, Melissa M. Tavarez |
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| Rok vydání: | 2017 |
| Předmět: |
Diarrhea
Male medicine.medical_specialty Quality management Vomiting MEDLINE Pharmacy Electronic mail Feedback 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Intervention (counseling) Medicine Humans Prospective Studies Practice Patterns Physicians' Prospective cohort study Child Electronic Mail business.industry 030208 emergency & critical care medicine General Medicine Emergency department medicine.disease Quality Improvement Hospitalization Emergency medicine Emergency Medicine Health Resources Female Medical emergency medicine.symptom business Emergency Service Hospital |
| Zdroj: | Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 24(8) |
| ISSN: | 1553-2712 |
| Popis: | Objectives Higher resource utilization in the management of pediatric patients with undifferentiated vomiting and/or diarrhea does not correlate consistently with improved outcomes or quality of care. Performance feedback has been shown to change physician practice behavior and may be a mechanism to minimize practice variation. We aimed to evaluate the effects of electronic mail (e-mail) only, provider-level performance feedback on the ordering and admission practice variation of pediatric emergency physicians for patients presenting with undifferentiated vomiting and/or diarrhea. Design: We conducted a prospective, quality improvement intervention and collected data over 3 consecutive fiscal years (FY). Setting: Single, tertiary-care pediatric emergency department. Participants: We collected admission and ordering practices data on 19 physicians during baseline, intervention and post-intervention periods. Intervention: We provided physicians with quarterly email-based performance reports during the intervention phase. Main Outcomes Measured: We measured admission rate and created four categories for ordering practices: no orders, laboratory orders, pharmacy orders and radiology orders. Results There was wide (2-3 fold) practice variation among physicians. Admission rates ranged from 15-30%, laboratory orders from 19-43%, pharmacy orders from 29-57%, and radiology orders from 11-30%. There was no statistically significant difference in the proportion of patients admitted or with radiology or pharmacy orders placed between pre-intervention, intervention or post-intervention periods (p = 0.58, p = 0.19, and p = 0.75, respectively). There was a significant but very small decrease in laboratory orders between the pre-intervention and post-intervention periods. Conclusions Performance feedback provided only via e-mail to pediatric emergency physicians on a quarterly basis does not seem to significantly impact management practices for patients with undifferentiated vomiting and/or diarrhea. This article is protected by copyright. All rights reserved. |
| Databáze: | OpenAIRE |
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