Date of Award


Degree Type


Degree Name

Master of Science (MS)




J. Sibley


Quality of care in the Emergency Department may be influenced by several factors and Canada is in the process of training specialists in Emergency Medicine to improve and standardize emergency care. Emergency departments are increasingly used and medical staff and in the organization there is a wide variation in the of the departments. This proposal describes a design for a multi-centre cohort to answer the question: "Is there any difference in the quality of care provided in Ontario's Emergency Department (ED) by Emergency Room Physicians (EP), Casualty Officers (CO) and General Practioners (GP)?". The study is confined to 35 eligible hospitals, within 100 Km around Hamilton, with more than 300 beds, with an average visit in the ED of more than 100 visits/day, with full time medical coverage, supporting facilities and access to specialized consultations. Twenty-eight physicians will be selected randomly in each of the 3 physician categories, half of them will be in university affiliated hospitals. The outcome measure is the assessment of quality of care: 1) the "technical process" of care will be assessed using ten indicator conditions and the data will be collected by unobtrusive observation and chart review; 2) the "art of care" will be assessed by the ED nurse observer; 3) the "patient outcome" will be assessed two weeks after the ED visit by a phone interview done by a research assistant. Each physician will be observed during two shifts. Each case will be classified as urgent or non-urgent. More than 6 cases per physician need to be assessed to detect a 25% difference between the groups with a risk alpha of 1% (two tailed) and a risk beta of 5%. An analysis of variance will be used to detect a difference for the process score, the physician attitude score and the outcome score. The influence of six factors will be estimated with a multiple regression linear model: 1) university affiliation, 2) urgency of cases, 3) workload, 4) training level of physicians, 5) method of payment and 6) working hours in the ED. Also descriptive data on the structure of the ED will be studied. Thirteen months should permit the completion of the study.

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