• Chao-Jui Li, Yuan-Jhen Syue, Chia-Te Kung, Shih-Chiang Hung, Chien-Hung Lee, and Kuan-Han Wu.
• Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Public Health, College of Health Science, and Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
• Am. J. Med. Sci. 2016 Jun 1; 351 (6): 582-8.

ObjectivesThe relationship between the seniority of emergency physicians (EPs) and disposition decision-making is not well defined. As most responsibility by EPs involves developing an appropriate disposition plan, this study aimed to examine the influence of EP seniority on decisions regarding patient dispositions in the emergency department (ED).Materials And MethodsThis retrospective, 1-year, cohort study was conducted in 3 EDs including all day-shift nontraumatic adult patients. The outcome involves patient dispositions at the end of the shift, patient final dispositions and patient 72-hour ED return. The EPs were categorized into the following 3 groups according to seniority: junior group (≤5 years of work experience), intermediate group (6-10 years) and senior group (>10 years).ResultsThe dispositions of 68,333 ED patients as determined by the 59 full-time EPs were studied. Compared to junior and intermediate EPs, senior EPs kept more patients in the ED (2.7% more than junior EP, 2.3% more than intermediate EP); they had the lowest patient mortality rate especially in first triage patients (3.4% fewer than junior EP, 1.3% fewer than intermediate EP); they took more time for patient discharge (0.2 more hours than junior EP, 0.1 more hours than intermediate EP); they had fewer patients return to the ED within 72 hours after discharge (0.5% fewer than junior EP, 0.3% fewer than intermediate EP).ConclusionsSenior EPs had the best quality of care (lowest mortality, fewest 72-hour returns). This best quality of care is accompanied with a slightly longer length of stay.Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

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