Effectiveness of Emergency Management by the Medical Staff in the Emergency Department

ABSTRACT

PURPOSE: In most emergency departments (EDs), primary care is managed by medically inexperienced interns or general physicians. The resulting reduction in the quality of management and the long time necessary to manage patients leads to overcrowding of the ED. Thus, effective ED management, which can be achieved through primary care by doctors with licenses of emergency medicine, is required. METHODS: The author performed a retrospective analysis and compared 475 patients who visited our hospital from June 20, 2000, to June 26, 2000, which was during the doctors' strike period (SP) to 234 patients who visited our hospital from June 22, 1999, to June 28, 1999, during the nonstrike period (NSP). RESULTS: The total of 475 patients during the SP is significantly higher than the total of 234 patients during the NSP (p<0.01). The mean of 1.58, for the number of emergency laboratory test per patient during the SP was significantly lower than the mean of 2.21 during the NSP. As to emergency mangagement cases during the SP compared to the cases during the NSP, the number of simple management cases increased and the number of complex management cases decreased. As to the patients' lengths of stay (LOS) in ED, 79 patients (63.7%) during the SP were admitted within 3 hours, while 305 patients (86.9%) during the SP were discharged within 3 hours, so significance difference is present between the two groups (p< 0.05 ). CONCLUSION: This study demonstrates that replacing residents with staff physicians results in fewer laboratory tests ordered, fewer radiologic studies ordered, and shorter lengths of stay in the ED.