Billboards nationwide boast emergency room wait times — an oft-cited statistic of efficiency. But one way to boost efficiency, without increasing cost, may be to allow emergency department physicians to manage their own workloads, according to a new study by David Chan, MD, PhD, an assistant professor of medicine.
A Stanford Health Policy article explains:
Chan studied two organizational models: one in which physicians are assigned patients in a nurse-managed system and one in which the doctors divide patients among themselves in a self-managed system...
He said that by simply allowing physicians to choose patients, a self-managed system reduces emergency room lengths of stay by 11-15 percent, relative to the nurse-managed system.
When a triage nurse assigns patients, doctors may be tempted to keep a patient longer than necessary, knowing that as soon as they are finished with one patient, they will be assigned another, Chan says. But when doctors work together, they can get a sense of other physicians' workloads, and divvy patients up more efficiently, he found.
The study draws on data from a large emergency department that saw 380,699 patients over six years. Chan analyzed how long each patient stayed in the emergency room and the amount of time they were assigned to an individual physician. He also tracked demographics and the severity of the patients' conditions.
The research might pave the way for future insights into efficiency, Chan said, explaining:
I think the biggest takeaway is that such efficiency gains can be widespread in health care, particularly because there is so much at stake hidden behind information in patient care that is not transparent...
Even if we don’t fully anticipate all of these gains, we could still achieve a lot by tinkering and using these changes as natural experiments to figure out what works and what doesn’t.
The study appears in the Journal of Political Economy.