Who is Coming In? Evaluation of Physician Performance Within Multi-Physician Emergency Departments

Who is Coming In? Evaluation of Physician Performance Within Multi-Physician Emergency Departments

Authors: Rohit B. Sangal, Robert Teresi, Meir Dashevsky, et al.
Journal: American Journal of Emergency Medicine, 2025

Conclusions:

  1. Co-Attending Influence:

    • Physician performance is influenced by the speed of co-attending physicians.

    • Fast physicians adjust their throughput and imaging practices based on the presence of fast or slow co-attendings.

  2. Staffing Implications:

    • Balancing physician speeds in multi-attending EDs may enhance operational efficiency.

    • Teams composed solely of the fastest or slowest physicians could have unintended impacts on throughput and resource utilization.

Methods:

  • Design: Retrospective observational study

  • Data Source: Patient data from two EDs (January 2018–February 2020)

  • Participants: 80 physicians and 212,902 ED visits

  • Metrics:

    • Speed measurement: Machine learning predicted patient length of stay (LOS) for an average-speed physician, adjusted for patient and departmental factors. Actual LOS was compared to this baseline to classify physician speed.

    • Outcomes: Patient LOS, patients treated per hour, imaging utilization, admission rates, and 72-hour ED revisits

  • Analysis: Linear regression assessed the relationship between a physician's performance and the speed of co-attending physicians.

Results:

Key Findings:

  1. Impact of Fast Co-Attendings:

    • Fastest physicians had a 17.8% shorter LOS compared to average-speed attendings.

    • When paired with fast co-attendings, this benefit dropped to 14.9%, representing a 2.9% longer LOS.

    • Patients seen per hour decreased by 0.08 when fast physicians worked with fast co-attendings.

    • Imaging utilization benefits reduced by 0.05 fewer tests per patient.

  2. Impact of Slow Co-Attendings:

    • When slow co-attendings were present, fast physicians:

      • Had faster throughput.

      • Ordered fewer imaging tests.

  3. Admission and Revisit Rates:

    • Co-attending speed had no significant impact on admission rates or 72-hour ED revisit rates.

  4. Operational Efficiency:

    • Slower attending teams experienced 6.4% higher waiting room volumes over an 8-hour shift.

    • Fastest attending teams had no significant increase in waiting room volumes.

Sangal, R.B., Teresi, R., Dashevsky, M., Ulrich, A., Tarabar, A., Parwani, V., Van Tonder, R., King, M. and Venkatesh, A.K., 2025. Who is coming in? Evaluation of physician performance within multi-physician emergency departments. The American Journal of Emergency Medicine.

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