This article describes how Length of Stay (LOS) differs between physicians in the Emergency Department (ED). The authors studied five EDs over three years, retrospectively, excluding "fast-track" visits (a system applied to treat patients with less serious conditions quickly). They report each provider’s observed LOS, as well as each provider’s ratio of observed LOS/expected LOS (LOSO/E). They determine expected LOS based on site average, adjusted for: 1) the patient characteristics of age, gender, acuity, and disposition status (admitted to hospital or discharged home), and 2) the time characteristics of shift, day of week, season, and calendar year. 327,753 visits seen by 92 physicians were eligible for analysis. For the five sites, the average shortest observed LOS was 151 min (range 106–184 min), and the average longest observed LOS was 232 min (range 196–270 min); the average difference was 81 min (range 69–90 min). For LOSO/E, the average lowest LOSO/E was 0.801 (range 0.702–0.887), and the average highest LOSO/E was 1.210 (range 1.186–1.275); the average difference between the lowest LOSO/E and the highest LOSO/E was 0.409 (range 0.305–0.493). There are, thus, significant differences in ED LOS at the level of the individual physician, even after accounting for multiple confounders.
Traub SJ, Saghafian S, Judson K et al. Interphysician Differences in Emergency Department Length of Stay. The Journal of Emergency Medicine 2018. https://doi.org/10.1016/j.jemermed.2017.12.041
Not open access.