Procedural frequency: Results from 18 academic, community and freestanding emergency departments

Title

Procedural frequency: Results from 18 academic, community and freestanding emergency departments

Creator

Do ELS; Smalley CM; Meldon SW; Borden BL; Briskin I; Muir MR; Suchan A; Delgado F; Fertel BS

Publisher

Journal Of The American College Of Emergency Physicians Open

Date

2020
2020-12

Description

BackgroundEmergency physicians must maintain procedural skills, but clinical opportunities may be insufficient. We sought to determine how often practicing emergency physicians in academic, community and freestanding emergency departments (EDs) perform 4 procedures: central venous catheterization (CVC), tube thoracostomy, tracheal intubation, and lumbar puncture (LP). MethodsThis was a retrospective study evaluating emergency physician procedural performance over a 12-month period. We collected data from the electronic records of 18 EDs in one healthcare system. The study EDs included higher and lower volume, academic, community and freestanding, and trauma and non-trauma centers. The main outcome measures were median number of procedures performed. We examined differences in procedural performance by physician years in practice, facility type, and trauma status. ResultsOver 12 months, 182 emergency physicians performed 1582 of 2805 procedures (56%) and supervised (resident, nurse practitioner or physician assistant) an additional 1223 of the procedures they did not perform (43%). Median (interquartile range) physician performance for each procedure was CVC 0 [0, 2], tube thoracostomy 0 [0, 0], tracheal intubation 3 [0.25, 8], and LP 0 [0, 2]. The percentage of emergency physicians who did not perform at least one of each procedure during the 1-year time frame ranged from 25.3% (tracheal intubation) to 76.4% (tube thoracostomy). Physicians who work at high-volume EDs (>50,000 visits per year) performed nearly twice as many tracheal intubations, CVCs, and LPs than those at low-volume EDs or freestanding EDs when normalized per 1000 visits. Years out of training were inversely related to total number of procedures performed. Emergency physicians at trauma centers performed almost 3 times as many tracheal intubations and almost 4 times as many CVCs compared to non-trauma centers. ConclusionIn a large healthcare system, regardless of ED type, emergency physicians infrequently performed the 4 procedures studied. Physicians in high-volume EDs, trauma centers, and recent graduates performed more procedures. Our study adds to a growing body of research that suggests clinical frequency alone may be insufficient for all emergency physicians to maintain competency.

Subject

emergency medicine; ACQUISITION; DELIBERATE PRACTICE; EXPERT PERFORMANCE; MEDICINE; procedural skills; skills maintenance

Identifier

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Format

journalArticle

Search for Full-text

Users with a NEOMED Library login can search for full-text journal articles at the following url: https://libraryguides.neomed.edu/home

Pages

1669-1675

Issue

6

Volume

1

ISSN

2688-1152

NEOMED College

NEOMED College of Medicine

NEOMED Department

Department of Emergency Medicine
NEOMED Student Publications

Update Year & Number

July 2021 List

Affiliated Hospital

Cleveland Clinic Akron General Hospital

Citation

Do ELS; Smalley CM; Meldon SW; Borden BL; Briskin I; Muir MR; Suchan A; Delgado F; Fertel BS, “Procedural frequency: Results from 18 academic, community and freestanding emergency departments,” NEOMED Bibliography Database, accessed October 20, 2021, https://neomed.omeka.net/items/show/11746.

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