Quantifying off-hour emergency physician coverage of in-hospital codes: a survey of community emergency departments.

Background: Community emergency physicians (EPs) are often required to respond to unstable patients outside of their department during off-hours.

Objective: The primary objective of this study was to describe the critical care responsibility of community EPs outside of their departments.

Methods: A one-page survey was mailed to emergency department (ED) directors of 10 states and Washington, DC.

Results: Three hundred forty of 1169 surveys were returned. The median (interquartile range [IQR]) number of hospital and intensive care unit (ICU) beds was 145 (IQR 60-242) and 11 (IQR 6-20), respectively. Median ED annual volume and ICU admission percentage was reported to be 25K (IQR 14-40) and 5% (IQR 2-10), respectively. Seventy-six percent of reporting institutions require EPs to leave their department and respond to medical codes on the floors after hours. In 57% of institutions, the EP was the only physician required to respond. In addition, 48% of EPs must respond to unstable patients in the ICUs after hours. Hospitals in which EPs were required to respond to medical codes and unstable ICU patients were more likely to have fewer hospital beds (137 vs. 275; p<0.001), fewer ICU beds (12 vs. 27; p<0.001), and have a smaller ED annual volume (24 K vs. 39 K; p<0.001).

Conclusions: Many community EPs are responsible for covering critically ill patients outside of their ED. Further investigation is required to determine the impact on patient care.