Abstract :- Since the introduction and passage of the Affordable Care Act (ACA), it has been clear that value-based service, without compromising quality or patient safety, will be necessary.Providing a value based service in the emergency department of a critical access hospital is in part dependent upon the physician staffing model. Although the literature is rich with information about many of the study key areas, very little was discovered that describes healthcare delivery service innovation, particularly as it relates to emergency department physician staffing models in a critical access hospital. This study utilized quantitative research methods, descriptive and an inferential statistical approach to investigate the performance of emergency department physician staffing models on acute myocardial infarction/chest pain outpatient core measures. The emergency department patient visit volume was less than 10,000 per year and three (3) different physician staffing models were evaluated over a five (5) year period; 2013 – 2018. The outpatient core measures for acute myocardial infarction/chest pain, that was analyzed was aspirin administration within 24 hours of admission and was an electrocardiogram done within 10 minutes of admission.

The research study discovered that there is a significant association between the emergency department physician staffing model and core measure performance for patients presenting with symptoms of an acute myocardial infarction/chest pain. Specifically, the board certified emergency medicine physician staffing model (B) and board certified primary care physician staffing model (C) outperformed the mixed specialty physician staffing model (A).This study highlighted the similarity in performance between different emergency department staffing models in a critical access hospital, as viewed by board certification and treating acute myocardial infarction/chest pain. Being able to determine that patients presenting with an acute myocardial infarction/chest pain are not compromised by changes within emergency department physician staffing composition is important when a decision to use an alternative staffing model is made by administrators.

Keywords: Acute myocardial infarction/chest pain, emergency department physician staffing model, core measure performance