Interphysician Differences in Emergency Department Length of Stay

Abstract Background Emergency physicians differ in many ways with respect to practice. One area in which interphysician practice differences are not well characterized is emergency department (ED) length of stay (LOS). Objective To describe how ED LOS differs among physicians. Methods We performed a 3-year, five-ED retrospective study of non-fast-track visits evaluated primarily by physicians. We report each provider's observed LOS, as well as each provider's ratio of observed LOS/expected LOS (LOS O/E ); we determined expected LOS based on site average adjusted for the patient characteristics of age, gender, acuity, and disposition status, as well as the time characteristics of shift, day of week, season, and calendar year. Results Three hundred twenty-seven thousand, seven hundred fifty-three 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 LOS O/E , the average lowest LOS O/E was 0.801 (range 0.702–0.887), and the average highest LOS O/E was 1.210 (range 1.186–1.275); the average difference between the lowest LOS O/E and the highest LOS O/E was 0.409 (range 0.305–0.493). Conclusion There are significant differences in ED LOS at the level of the individual physician, even after accounting for multiple confounders. We found that the LOS O/E for physicians with the lowest LOS O/E at each site averaged approximately 20% less than predicted, and that the LOS O/E for physicians with the highest LOS O/E at each site averaged approximately 20% more than predicted.