{"pk":14642,"title":"The Effects of Implementing a “Waterfall” Emergency Physician Attending Schedule","subtitle":null,"abstract":"Introduction:\n Increases in emergency department (ED) crowding and boarding are a nationwide issue resulting in worsening patient care and throughput. To compensate, ED administrators often look to modifying staffing models to improve efficiencies. \nMethods:\n This study evaluates the impact of implementing the waterfall model of physician staffing on door-to-doctor time (DDOC), door-to-disposition time (DDIS), left without being seen (LWBS) rate, elopement rate, and the number of patient sign-outs. We examined 9,082 pre-intervention ED visits and 8,983 post-intervention ED visits. \nResults:\n The change in DDOC, LWBS rate, and elopement rate demonstrated statistically significant improvement from a mean of 65.1 to 35 minutes (P <0.001), 1.12% to 0.92% (P = 0.004), and 3.96% to 1.95% (P <0.001), respectively. The change in DDIS from 312 to 324.7 minutes was not statistically significant (P = 0.310). The number of patient sign-outs increased after the implementation of a waterfall schedule (P <0.001). \nConclusion:\n Implementing a waterfall schedule improved DDOC time while decreasing the percentage of patients who LWBS and eloped. The DDIS and number of patient sign-outs appears to have increased post implementation, although this may have been confounded by the increase in patient volumes and ED boarding from the pre- to post-intervention period.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Medicine, Physician Schedules, Door to Doctor time, Door to Disposition Time, Left without being seen, Academic Medicine"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3nm108qw","frozenauthors":[{"first_name":"Lindsey","middle_name":"","last_name":"Spiegelman","name_suffix":"","institution":"University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Maxwel","middle_name":"","last_name":"Jen","name_suffix":"","institution":"University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Danielle","middle_name":"","last_name":"Matonis","name_suffix":"","institution":"University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Ryan","middle_name":"","last_name":"Gibney","name_suffix":"","institution":"University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Saadat","middle_name":"","last_name":"Soheil","name_suffix":"","institution":"University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Sangeeta","middle_name":"","last_name":"Sakaria","name_suffix":"","institution":"University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Alisa","middle_name":"","last_name":"Wray","name_suffix":"","institution":"University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Shannon","middle_name":"","last_name":"Toohey","name_suffix":"","institution":"University of California Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"}],"date_submitted":"2020-10-13T20:34:16-04:00","date_accepted":"2020-10-13T20:34:16-04:00","date_published":"2021-07-20T15:10:34-04:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/14642/galley/7466/download/"}]}