{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:59:45Z","timestamp":1791395985724,"version":"4.3.3"},"reference-count":15,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency physicians working prolonged shifts may show temporal variation in clinical practice. We examined whether diagnostic resource utilization differed across scheduled shift periods in a structured low-acuity emergency department setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study included 11\u2009032 visits for upper respiratory tract infection, myalgia, abdominal pain, or headache across 12 nonconsecutive 24-hour shifts (5 December 2025\u201319 January 2026) in a high-volume tertiary emergency department in Turkey. Visits were classified as early (0\u20135\u00a0h; 08:30\u201313:30), mid (5\u201310\u00a0h; 13:30\u201318:30), or late (10\u201316\u00a0h; 18:30\u201300:30) based on elapsed time since the scheduled shift start at 08:30. Multivariable logistic regression with physician-level clustered standard errors (19 clusters) adjusted for age, sex, and diagnostic category.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Laboratory testing rates were 9.5% across all periods (P\u2009=\u2009.997); imaging rates were 13.5%, 12.8%, and 12.6% (P\u2009=\u2009.485). The composite utilization score did not differ significantly (P\u2009=\u2009.682). Late-period consultation was lower than in the early period (odds ratio\u2009=\u20090.541, 95% confidence interval: 0.306\u20130.957), although this finding was limited by the low event count (n\u2009=\u200982). Inter-physician variation substantially exceeded shift-period variation, with laboratory rates ranging from 3.5% to 21.5% and imaging rates from 6.3% to 28.7%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this low-acuity emergency department setting, scheduled shift period was not measurably associated with increased laboratory or imaging utilization. Physician-level variation appeared more prominent than shift-period variation, supporting prospective studies incorporating fatigue, workload, and decision-quality measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/postmj\/qgag142","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:27:12Z","timestamp":1789673232000},"source":"Crossref","is-referenced-by-count":0,"title":["Physician-level variation exceeds time-of-day variation in diagnostic resource utilization in low-acuity emergency department care"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7089-0000","authenticated-orcid":false,"given":"Mehmet \u015eirin","family":"B\u00fcy\u00fckkaya","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Van Training and Research Hospital, University of Health Sciences , S\u00fcphan Hava Yolu Kav\u015fa\u011f\u0131 1. Kilometre, Edremit, Van 65300 ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mesut","family":"Kina","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Van Training and Research Hospital, University of Health Sciences , S\u00fcphan Hava Yolu Kav\u015fa\u011f\u0131 1. Kilometre, Edremit, Van 65300 ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmut","family":"\u015eahin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Van Training and Research Hospital, University of Health Sciences , S\u00fcphan Hava Yolu Kav\u015fa\u011f\u0131 1. Kilometre, Edremit, Van 65300 ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"Tatli","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Van Training and Research Hospital, University of Health Sciences , S\u00fcphan Hava Yolu Kav\u015fa\u011f\u0131 1. Kilometre, Edremit, Van 65300 ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramazan Sami","family":"Akta\u015f","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Van Training and Research Hospital, University of Health Sciences , S\u00fcphan Hava Yolu Kav\u015fa\u011f\u0131 1. 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