Document Type : Original Article


1 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences Health Management and Economics Research Center, Iran University of Medical Sciences

2 Department of Health in Emergencies and Disasters, School of Health Management and Information Sciences, Iran University of Medical Sciences

3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences

4 Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran


INTRODUCTION: The performance of the emergency department (ED) as one of the main parts of
hospitals, have a great impact on the performance of the whole‑hospital. In Iran, the official education
program of this discipline was started in 2001 and has expanded in most medical universities. Given
the unprecedentedness of emergency medicine (EM), there are limited studies about this specialty.
Thus, this study aims to explore the status, role, and performance of Iranian EM specialists.
MATERIALS AND METHODS: This qualitative study was conducted using content analysis of 19
semi‑structured interviews with EM specialists and key informant. Purposive sampling was conducted,
and some teaching and nonstate hospitals in different geographic regions of Tehran city were selected.
Conducting interviews continued until reaching the data saturation. Thematic analysis was employed.
Extracted themes were reviewed and confirmed by some of the participants.
RESULTS: The study results were categorized within five main themes; included the role of ED
from EM specialists’ viewpoint, EM specialists’ viewpoint on their discipline, performance of EM
specialists (including medical, managerial, and economic performance), and role of EM specialists
in patient satisfaction; and opportunities and challenges of EM specialists.
CONCLUSION: Overall, the study findings highlighted the effectiveness and positive medical,
managerial and economic impacts of EM in Iran, inside and beyond hospitals. However, the
study addressed significant opportunities some solvable challenges in educational, professional
and economic domains, and interdisciplinary relationships. Further studies are recommended for
comprehensive exploring viewpoint of other disciplines and stakeholders.


  1. Bahadori MK, Mirhashemi SE, Panahi FA, Zaboli R, Rezaee M.
    Structure, process and practices of the emergency unit of hospitals
    of Baqyatallah University of medical sciences. J Mil Med 2008;
    2. Chardoli M, Mayel M, Mofidi M, Rezai M. Assessment of
    emergency department with emergency medicine specialists
    regard to ministry of health standards in Tehran. J Med Counc
    Islam Repub Iran 2011; 29:338‑46.
    3. Nowacki AK, Landes M, Azazh A, Puchalski Ritchie LM. A review
    of published literature on emergency medicine training programs
    in low – And middle‑income countries. Int J Emerg Med 2013;
    4. Jalili M. Emergency medicine in Iran, past and present. Acad
    Emerg Med 2007; 14:832.
    5. Moharari RS, Soleymani HA, Nejati A, Rezaeefar A, Khashayar P,
    Meysamie AP, et al. Evaluation of morning report in an emergency
    medicine department. Emerg Med J 2010; 27:32‑6.
    6. Shirani F, Jalili M, Asl‑E‑Soleimani H. Discharge against medical
    advice from emergency department: Results from a tertiary care
    hospital in Tehran, Iran. Eur J Emerg Med 2010; 17:318‑21.
    7. HashemiB, BaratlooA, Rahmati F, ForouzanfarMM, MotamediM,
    Safari S, et al. Emergency department performance indexes before
    and after establishment of emergency medicine. Emerg (Tehran)
    2013; 1:20‑3.
    8. Welch SJ, Asplin BR, Stone‑Griffith S, Davidson SJ, Augustine J,
    SchuurJ, et al. Emergency department operational metrics, measures
    and definitions: Results of the second performance measures and
    benchmarking summit. Ann Emerg Med 2011; 58:33‑40.
    9. Glickman SW, Schulman KA, Peterson ED, Hocker MB, Cairns CB.
    Evidence‑based perspectives on pay for performance and quality
    of patient care and outcomes in emergency medicine. Ann Emerg
    Med 2008; 51:622‑31.
    10. Braun V, Clarke V, Terry G. Thematic analysis. Qual Res Clin
    Health Psychol 2014; 24:95‑114.
    11. Joffe H, Yardley L. Content and thematic analysis. Res Methods
    Clin Health Psychol 2004; 56:68.
    12. Farahmand S, Karimialavijeh E, Vahedi HS, Jahanshir A.
    Emergency medicine as a growing career in Iran: An internet‑based
    survey. World J Emerg Med 2016; 7:196‑202.
    13. Baratloo A, Maleki M. Description of a working day as a senior
    emergency medicine resident; burning candle at both ends!
    Emerg (Tehran) 2015; 3:1.
    14. Baratloo A, Maleki M. Iranian emergency department
    overcrowding. J Emerg Pract Trauma 2015; 1:39.
    15. Esmaeilpour M, Salsali M, Ahmadi F. Workplace violence against
    Iranian nurses working in emergency departments. Int Nurs Rev
    2011; 58:130‑7.
    16. Teymourzadeh E, Rashidian A, Arab M, Akbari‑Sari A,
    Hakimzadeh SM. Nurses exposure to workplace violence in a
    large teaching hospital in Iran. Int J Health Policy Manag 2014;
    17. Pandey NR. Emergency medicine in Nepal: Present practice and
    direction for future. Int J Emerg Med 2016; 9:20.
    18. Jiao M, Ning N, LiY, Gao L, CuiY, Sun H, et al. Workplace violence
    against nurses in Chinese hospitals: A cross‑sectional survey. BMJ
    Open 2015;5: e006719.
    19. Angland S, Dowling M, Casey D. Nurses’ perceptions of the
    factors which cause violence and aggression in the emergency
    department: A qualitative study. Int Emerg Nurs 2014; 22:134‑9.
    20. Hoot NR, AronskyD. Systematic review of emergency department
    crowding: Causes, effects, and solutions. Ann Emerg Med 2008;
    21. Flowerdew L, Brown R, Russ S, Vincent C, Woloshynowych M.
    Teams under pressure in the emergency department: An
    interview study. Emerg Med J 2012;29: e2.
    22. Johnston A, Abraham L, Greenslade J, Thom O, Carlstrom E,
    Wallis M, et al. Review article: Staff perception of the emergency
    department working environment: Integrative review of the
    literature. Emerg Med Australas 2016; 28:7‑26.
    23. Amiresmaili MR, Nekooi Moghadam M, Saberi Nia A,
    Ghorbani Nia R. The effect of 24‑hour presence of emergency
    medicine specialists on the performance of emergency department
    of Shahid Bahonar hospital, Kerman, Iran, 2013. J Emerg Pract
    Trauma 2015; 1:23‑7.
    24. Paltved C, Musaeus P. Qualitative research on emergency
    medicine physicians: A literature review. Int J Clin Med 2013;
    25. Nicks BA, Nelson D. Emergency department operations and
    management education in emergency medicine training. World
    J Emerg Med 2012; 3:98‑101.
    26. Francis RC, Spies CD, Kerner T. Quality management and
    benchmarking in emergency medicine. Curr Opin Anaesthesiol
    2008; 21:233‑9.
  2. 27. Asadi P, Kasmaie VM, Zohrevandi B, Ziabari SM, Marzbani BB.
    Disposition of patients before and after establishment of
    emergency medicine specialists. Iran J Emerg Med 2014; 1:28‑33.
    28. Amini A, Dindoost P, Moghimi M, Kariman H, Shahrami A,
    Dolatabadi AA, et al. Clinical audit of emergency unit before and
    after establishment of the emergency medicine department. J Pak
    Med Assoc 2012; 62:154‑8.
    29. Holliman CJ, Mulligan TM, Suter RE, Cameron P, Wallis L,
    Anderson PD, et al. The efficacy and value of emergency medicine:
    A supportive literature review. Int J Emerg Med 2011; 4:44.
    30. Shahrami A, Rahmati F, Kariman H, Hashemi B, Rahmati M,
    Baratloo A, et al. Utilization of failure mode and effects
    analysis (FMEA) method in increasing the revenue of
    emergency department; a prospective cohort study.
    Emerg (Tehran) 2013; 1:1‑6.
    31. Abbasi S, Farsi D, Bahrani M, Davari S, Pishbin E, Kianmehr N,
    et al. Emergency medicine specialty may improve patient
    satisfaction. Med J Islam Repub Iran 2014; 28:61.
    32. Welch SJ. Twenty years of patient satisfaction research applied
    to the emergency department: A qualitative review. Am J Med
    Qual 2010; 25:64‑72.
    33. Cydulka RK, Korte R. Career satisfaction in emergency medicine:
    The ABEM longitudinal study of emergency physicians. Ann
    Emerg Med 2008; 51:714‑220.
    34. Geiderman JM, Iserson KV, Marco CA, Jesus J, Venkat A. Conflicts
    of interest in emergency medicine. Acad Emerg Med 2017;
    35. Yarmohammadian MH, Rezaei F, Haghshenas A, Tavakoli N.
    Overcrowding in emergency departments: A review of strategies
    to decrease future challenges. J Res Med Sci 2017; 22:23.