AEM Education and Training 14: Emergency Medicine Resident Efficiency and Emergency Department Crowding

Welcome to the fourteenth episode of AEM Education and Training, a podcast collaboration between the Academic Emergency Medicine E&T Journal and Brown Emergency Medicine. Each quarter, we'll give you digital open access to AEM E&T Articles or Articles in Press, with an author interview podcast and links to curated supportive educational materials for EM learners and medical educators.

Find this podcast series on iTunes here.

DISCUSSING (CLICK ON TITLE TO ACCESS):

Emergency Medicine Resident Efficiency and Emergency Department Crowding. Ryan Kirby, MD, Richard D. Robinson, MD, Sasha Dib, MD, Daisha Mclarty, MD, Sajid Shaikh, MS, Radhika Cheeti, Amy F. Ho, MD, Chet D. Schrader, MD, Nestor R. Zenarosa, MD, Hao Wang MD, PhD

LISTEN NOW: INTERVIEW WITH AUTHORS Ryan Kirby, MD and Hao Wang MD, PhD

Ryan Kirby, MD, FACEP

Residency Program Director, Department of Emergency Medicine, John Peter Smith Health Network

Hao Wang MD, PhD, FACEP

Research Director, Department of Emergency Medicine, John Peter Smith Health Network

Abstract

Objectives

Provider efficiency has been reported in the literature but there is a lack of efficiency analysis among emergency medicine (EM) residents. We aim to compare efficiency of EM residents of different training levels and determine if EM resident efficiency is affected by emergency department (ED) crowding.

Methods

We conducted a single‐center retrospective observation study from July 1, 2014, to June 30, 2017. The number of new patients per resident per hour and provider‐to‐disposition (PTD) time of each patient were used as resident efficiency markers. A crowding score was assigned to each patient upon the patient's arrival to the ED. We compared efficiency among EM residents of different training levels under different ED crowding statuses. Dynamic efficiency changes were compared monthly through the entire academic year (July to next June).

Results

The study enrolled a total of 150,920 patients. A mean of 1.9 patients/hour was seen by PGY‐1 EM residents in comparison to 2.6 patients/hour by PGY‐2 and ‐3 EM residents. Median PTD was 2.8 hours in PGY‐1 EM residents versus 2.6 hours in PGY‐2 and ‐3 EM residents. There were no significant differences in acuity across all patients seen by EM residents. When crowded conditions existed, residency efficiency increased, but such changes were minimized when the ED became overcrowded. A linear increase of resident efficiency was observed only in PGY‐1 EM residents throughout the entire academic year.

Conclusion

Resident efficiency improved significantly only during their first year of EM training. This efficiency can be affected by ED crowding.