Provider variation in fast track treatment time

Objective: To examine the degree to which fast track (FT) treatment time varies among providers. Methods: A retrospective cohort study that included 105,783 FT visits at 3 emergency departments (EDs) during a 3-year period. We calculated the median treatment time for 80 primary providers (physicians and physician extenders) and 109 nurses (2 sites only). We used a hierarchical linear regression model that accounted for the clustering of patient visits to the same provider to estimate each provider's median treatment time controlling for patient, clinical, temporal, and ED demand (ie, number of arrivals) characteristics. Results: Median FT treatment time across the 3 sites ranged from 48 to 134 minutes. Adjusted for other factors, the median FT treatment time of providers at the 90th versus 10th percentiles was 1.4 to 2.6 times longer across the 3 sites. The variation by FT nurses was also large. The median FT treatment time of nurses at the 90th versus 10th percentiles was 1.5 and 1.4 times longer at sites A and C, respectively. At all sites, provider and clinical factors explained more variation in FT treatment time than patient, ED demand, or temporal factors. Conclusions: There were clinically meaningful differences in FT treatment time among the providers at all sites. Given that the providers share the same environment and patient population, understanding why such large provider variation in FT treatment time exists warrants further investigation.