Are You a Test/Admit or Treat/Street Doc?

Written by Clay Smith

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There was a positive correlation with individual physician resource utilization and hospital admission. Testers are admitters.

Why does this matter?
In an era of increasing cost consciousness in healthcare, resource utilization and admission rates are coming under greater scrutiny. Are physicians who are prone to heavy resource utilization also prone to admit more patients to the hospital? If so, is this a good or bad thing? This study answers the first question but not the second.

Test/Admit or Treat/Street
This was a retrospective review of two EDs, both without EM residency programs. There was a positive correlation with individual physician resource utilization and hospital admission. Resource utilization was defined as giving IV fluid/medication, ordering labs, x-rays, or advanced imaging - CT, ultrasound, or MRI. Heavy resource users were heavy admitters; low-resource utilizers had lower hospital admission rates. They compared the observed admission and resource utilization rates with expected admission and testing rates. “Expected” rates were determined by patient’s, “age, sex, race, ESI score and time (shift, day of week, season, and study year).” This raises numerous questions. Did “tester/admitters” have better or worse patient outcomes? Why did some physicians “test and admit” and others “treat and street?” Would individual physician feedback and coaching change this, or is it inherent? Could clinical decision support tools or protocols reduce resource utilization and admission rates? We simply don’t know. Sounds like a good research project!

Source
Are testers also admitters? Comparing emergency physician resource utilization and admitting practices. Am J Emerg Med. 2018 Oct;36(10):1865-1869. doi: 10.1016/j.ajem.2018.07.041. Epub 2018 Jul 20.

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