Do Automated Reminders for Emergency Department Resident Physicians to Review Their Patient List Improve Efficiency?

OBJECTIVES: Navigating the emergency department (ED) workflow in an efficient manner is an important skill every emergency physician or advanced provider must master. There is a paucity of research into ways to improve how efficiently an ED provider works amid these distractions. This study seeks to determine whether the addition of an hourly automated reminder for resident physicians to review their patient list improves throughput metrics. METHODS: This a double-blinded randomized controlled trial in which resident physicians at a single community ED were randomly assigned to two groups: the intervention group, which received automated hourly notifications within the electronic medical record (EMR) to review their patient list for those whose workup is completed, and the control group, which received no notifications. We prospectively analyzed records for 25,255 encounters with 19,264 individual patients seen by 64 residents over the study period. Three-level mixed-effects regression models were used to examine whether notifications improved ED length of stay (ED-LOS), turnaround time to discharge (TAT-D), or turnaround time to admission (TAT-A). RESULTS: There was no statistically significant difference in ED-LOS or TAT-D between groups, but the average TAT-A was 20.00 minutes longer in the intervention group compared to the control group (p < 0.001), after accounting for patient- and resident-specific effects. Secondary analysis demonstrated no statistically significant effect of residency specialty on the effect of notifications on ED-LOS, TAT-D, or TAT-A. CONCLUSIONS: Automated hourly notifications within the EMR reminding residents in the ED to review their patient list did not reduce the ED-LOS, TAT-D, or TAT-A. However, the TAT-A was 20.00 minutes longer in the intervention group compared to the control group. It is unclear whether this represents an unintended effect of the automated reminders or is simply a spurious correlation.

Underutilization of the Emergency Department During the COVID-19 Pandemic.

INTRODUCTION: The novel coronavirus 2019 (COVID-19) pandemic in the United States (US) prompted widespread containment measures such as shelter-in-place (SIP) orders. The goal of our study was to determine whether there was a significant change in overall volume and proportion of emergency department (ED) encounters since SIP measures began. METHODS: This was a retrospective, observational, cross-sectional study using billing data from January 1, 2017-April 20, 2020. We received data from 141 EDs across 16 states, encompassing a convenience sample of 26,223,438 ED encounters. We used a generalized least squares regression approach to ascertain changes for overall ED encounters, hospital admissions, and New York University ED visit algorithm categories. RESULTS: ED encounters decreased significantly in the post-SIP period. Overall, there was a 39.6% decrease in ED encounters compared to expected volume in the pre-SIP period. Emergent encounters decreased by 35.8%, while non-emergent encounters decreased by 52.1%. Psychiatric encounters decreased by 30.2%. Encounters related to drugs and alcohol decreased the least, by 9.3% and 27.5%, respectively. CONCLUSION: There was a significant overall reduction in ED utilization in the post-SIP period. There was a greater reduction in lower acuity encounters than higher acuity encounters. Of all subtypes of ED encounters, substance abuse- and alcohol-related encounters reduced the least, and injury-related encounters reduced the most.