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ACEP 2012: Holding Orders & Performance-Based Compensation

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The Particulars: Recent research has suggested that having emergency physicians enter holding orders for stable adult inpatients can reduce ED length of stay by as much as 1 hour. However, this research also indicates that just 9.4% of emergency physicians use holding orders. A performance-based compensation measure might increase emergency physician adherence to holding order use.

Data Breakdown: A study was performed in which a performance-based compensation measure for holding order use was instituted in the ED setting. Investigators found that ED-based holding order use increased to 15.8% after the intervention. Average times from completion of the emergency physician evaluation to placement of an admitting bed order were 37 minutes for patients receiving ED-based holding orders, compared with 87 minutes for those without holding orders.

Take Home Pearls: Adherence to ED-based holding order use appears to increase with the use of performance-based compensation measures. Holding order use also appears to reduce the amount of time to bed order placement.

For additional ACEP 2012 coverage, visit www.physiciansweekly.com/acep-2012.

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