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The following is a summary of “Who is coming in? Evaluation of physician performance within multi-physician emergency departments,” published in the April 2025 issue of American Journal of Emergency Medicine by Sangal et al. 

Researchers conducted a retrospective study to explore how physician performance metrics were influenced by the speed of co-attendings concurrently staffing the ED.  

They used patient data from 2 EDs between January 2018 and February 2020. Machine learning predicted patient length of stay (LOS) based on assignment to an average-speed physician, incorporating patient- and departmental-level variables. A physician’s actual patient LOS was compared to model predictions to estimate their speed. Linear regression models analyzed how physician performance varied with the speed of concurrent ED co-attendings, assessing outcomes such as LOS, patients treated per hour, imaging utilization, admission rates, and 72-hour ED revisits (co-attendings).  

The results showed that 80 physicians and 2,12,902 ED visits were included. Patients assigned to the fastest physicians had a 17.8% [13.5%, 22.0%] shorter LOS compared to average-speed attendings. However, when the fastest physicians worked alongside the fastest co-attendings, the LOS benefit decreased to 14.9%, reflecting a 2.9% [0.2%, 5.6%] increase in LOS. The fastest physicians treated 0.21 [0.13, 0.28] more patients per hour than average attendings, but this advantage dropped to 0.13 [0.09, 0.17] more patients per hour with the fastest co-attendings, a reduction of 0.08 [0.04, 0.11] patients per hour. Imaging utilization was 0.18 [0.13, 0.23] tests per patient lower for the fastest physicians, but this reduction lessened by 0.05 [0.04, 0.07] imaging tests per patient when the fastest co-attendings were present. Similar effects, in the opposite direction, were observed with the slowest co-attendings. No significant association was found between co-attending speed and admission rates or 72-hour ED revisits. Compared to the average attending team speed, slower teams experienced a 6.4% [4.5%, 8.4%] increase in waiting room volume over an 8-hour shift, while no difference was observed with the fastest attending teams (−1.2% [−3.2%, 0.7%]).  

Investigators concluded that the presence of faster co-attendings was associated with slower physician throughput and increased imaging orders, while slower co-attendings correlated with faster throughput and fewer imaging orders. 

Source: sciencedirect.com/science/article/abs/pii/S0735675725000038