CJEM Articles: Ross Berringer

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  • Development, implementation and reliability assessment of an emergency physician performance evaluation tool
    October 2000 2 4
    Cosmas Leung, Grant Innes, James Christenson, Jeremy Etherington, Jonathan Berkowitz, Robert Chamberlain, Ross Berringer

    Evaluation of physician practice is necessary, both to provide feedback for self-improvement and to guide department heads during yearly evaluations.
    Objective: To develop and implement a peer-based performance evaluation tool and to measure reliability and physician satisfaction.
    Methods: Each emergency physician in an urban emergency department evaluated their peers by completing a survey consisting of 21 questions on effectiveness in 4 categories: clinical practice, interaction with coworkers and the public, nonclinical departmental responsibilities, and academic activities. A sample of emergency nurses evaluated each emergency physician on a subset of 5 of the questions. Factor analysis was used to assess the reliability of the questions and categories. Intra-class correlation coefficients were calculated to determine inter-rater reliability. After receiving their peer evaluations, each physician rated the process's usefulness to the individual and the department.
    Results: 225 surveys were completed on 16 physicians. Factor analysis did not distinguish the nonclinical and academic categories as distinct; therefore, the survey questions fell into 3 domains, rather than the 4 hypothesized. The overall intra-class correlation coefficient was 0.43 for emergency physicians, indicating moderate, but far from perfect, agreement. This suggests that variability exists between physician evaluators, and that multiple reviewers are probably required to provide a balanced physician evaluation. The intra-class correlation coefficient for emergency nurses was 0.11, suggesting poor reliability. Overall, 11 of 15 physicians reported the process valuable or mostly valuable, 3 of 15 were unsure and 1 of 15 reported that the process was definitely not valuable.
    Conclusion: Physician evaluation by a single individual is probably unreliable. A useful physician peer evaluation tool can be developed. Most physicians view a personalized, broad-based, confidential peer review as valuable.

  • Medical role of first responders in an urban prehospital setting
    July 1999 1 2
    Glenn Maddess, Jeff Freeman, Jim Christenson, John Spinelli, Maurice Blitz, Ross Berringer, Sandra Rae

    Background: Almost all North American cities have first responder programs. To date there is no published documentation of the roles first responders play, nor of the frequency and type of interventions they perform. Many urban stakeholders question the utility and safety of routinely dispatching large vehicles emergently to calls that may not require their services. Real world data on first responder interventions will help emergency medical services (EMS) directors and planners determine manpower requirements, assess training needs, and optimize dispatch protocols to reduce the rate of inappropriate “code 3” (lights and siren) responses.
    Objective: Our objectives were to determine how often first responders arrive first on scene, to estimate the time interval between first response and EMS response, and to examine the frequency and type of interventions performed by first responders. Methods: In a prospective observational study, trained observers were assigned to fire department first responder (FDFR) units. These observers recorded on-scene times for FDFR and EMS units, and documented the performance of first responder interventions.
    Results: FDFRs arrived first on scene in 49% of code 3 calls. They performed critical interventions in 18% of calls attended and 36% of calls where they arrived first. Oxygen administration was the most frequent critical intervention, yet occult hypoxemia was common and compliance with oxygen administration protocols was poor.
    Conclusions: First responders perform critical interventions during a minority of code 3 calls, even when “critical” is defined generously. Many “lights and siren” dispatches are unnecessary. Future research should attempt to identify dispatch criteria that more accurately predict the need for first responder intervention. First responder training and continuous quality improvement (CQI) should focus on interventions that are performed with some regularity, particularly oxygen administration.

  • Spine Trauma
    April 1999 1 1
    Ross Berringer