Decision-Making for Patients Referring to EmergencyDepartment Before and After the Establishment ofEmergency Medicine; a Comparative Study

The need for the training of emergency physicians was felt in the mid-20th century in response to rising public expectations for access to quality and specialized medical care around the clock. This study was conducted with the aim of comparing the decision-making status of patients referring to Imam Reza Hospital’s Emergency Department in Birjand before and after the establishment of emergency medicine.

In this comparative study, 800 patients who were admitted to the emergency department of Imam Reza Hospital, Birjand, Iran, from March to September in 2011 (before the establishment of emergency medicine) and 2017 (after the establishment of emergency medicine) were compared regarding the status of decision-making. Patient information (including patient demographics, reason for referral, length of hospital stay, and time to assignment, discharge or referral) was collected from a paper file or the hospital information system (HIS). After collecting the data, they were entered in SPSS software version 16 and Mann-Whitney and Chi-square tests were used at a significance level of 0.05.

Mean time to decision-making had reduced from 343.1 ± 222.73 minutes to 200.19 ± 174.33 minutes after the deployment of emergency medicine specialists (P<0.001). There was a significant difference between the frequency of discharge against medical advice, and decision-making regarding the patients in less than 6 hours and 12 hours between the two time periods (P<0.05). The number of patients who were referred to other medical centers and other wards was not significantly different between the two time periods (P>0.05).

The presence of emergency medicine specialists, as a successful model in the health system, led to an increase in speed, quality, and accuracy of providing services to patients admitted to the emergency department.