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Yousef A, Lauthen D, Ramsey C, Zhang X, Athas J, Jenusaitis M, Califano J. Trainees Associated with Improved Wait Times and Patient Satisfaction in a Multidisciplinary Clinic. Laryngoscope 2024; 134:178-184. [PMID: 37314126 DOI: 10.1002/lary.30821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/21/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine variables associated with longer wait times and decreased patient satisfaction. To determine the association of trainees with clinic wait times and patient satisfaction scores in an academic center. STUDY DESIGN Cross-sectional study. METHODS We recruited 266 study participants from an interdisciplinary Head and Neck Cancer outpatient clinic setting. Trained observers recorded observations related to wait times, time with individual health care practitioners, and total time spent in clinic. An 11-question survey was given to patients at the end of their visit assessing each patient's satisfaction with their visit, subjective wait time, and their likelihood to recommend the health care provider. RESULTS Increased objective wait times were associated with new patients (p = 0.006) and based on the physician they saw (p < 0.001). Patients who saw a trainee spent less time waiting to see a physician (p = 0.023), more total time with a physician (p = 0.001), and reported higher wait time satisfaction scores (p = 0.001). There was no difference in total visit time if patients saw a trainee (p = 0.42). Patient satisfaction with wait time was correlated with all other aspects of patient satisfaction (p < 0.001). On multivariable analysis, the subjective wait time was associated with the likelihood to recommend (p < 0.001). CONCLUSION Prolonged objective wait times in a multidisciplinary oncology outpatient setting were associated with several factors including specific physicians and new patient status. Trainee interaction with patients led to shorter wait times and improved patient satisfaction scores with wait times. Satisfaction with wait time was positively correlated with all aspects of patient satisfaction and 'likelihood to recommend' scores. LEVEL OF EVIDENCE NA Laryngoscope, 134:178-184, 2024.
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Affiliation(s)
- Andrew Yousef
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, California, USA
| | - David Lauthen
- Moores Cancer Center, University of California, San Diego, California, USA
| | - Celia Ramsey
- Moores Cancer Center, University of California, San Diego, California, USA
| | - Xinlian Zhang
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Jayna Athas
- Moores Cancer Center, University of California, San Diego, California, USA
| | - Matthew Jenusaitis
- Moores Cancer Center, University of California, San Diego, California, USA
| | - Joseph Califano
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, California, USA
- Moores Cancer Center, University of California, San Diego, California, USA
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2
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Alharbi AA, Muhayya M, Alkhudairy R, Alhussain AA, Muaddi MA, Alqassim AY, AlOmar RS, Alabdulaali MK. The pattern of emergency department length of stay in Saudi Arabia: an epidemiological Nationwide analyses of secondary surveillance data. Front Public Health 2023; 11:1265707. [PMID: 38162606 PMCID: PMC10757469 DOI: 10.3389/fpubh.2023.1265707] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024] Open
Abstract
Background Emergency department length of stay is a vital performance indicator for quality and efficiency in healthcare. This research aimed to evaluate the length of stay patterns in emergency departments across Saudi Arabia and to identify predictors for extended stays. The study used secondary data from the Ministry of Health's Ada'a program. Methods Using a retrospective approach, the study examined data from the Ada'a program on emergency department length of stay from September 2019 to December 2021. These data covered 1,572,296 emergency department visits from all regions of Saudi Arabia. Variables analyzed included quality indicators, year of visit, shift time, hospital type, and data entry method. The analysis was conducted using multiple linear regression. Results The study found that the median length of stay was 61 min, with significant differences among related predictors. All associations were significant with a value of p of less than 0.001. Compared to 2019, the length of stay was notably shorter by 28.5% in 2020 and by 44.2% in 2021. Evening and night shifts had a shorter length of stay by 5.9 and 7.8%, respectively, compared to the morning shift. Length of stay was lower in winter, summer, and fall compared to spring. Patients in levels I and II of the Canadian Triage and Acuity Scales had longer stays than those in level III, with those in level I reaching an increase of 20.5% in length of stay. Clustered hospitals had a longer length of stay compared to the non-clustered ones. Pediatric hospitals had a 15.3% shorter stay compared to general hospitals. Hospitals with data entered automatically had a 14.0% longer length of stay than those entered manually. Patients admitted to the hospital had a considerably longer length of stay, which was 54.7% longer compared to non-admitted patients. Deceased patients had a 20.5% longer length of stay than patients discharged alive. Conclusion Data at the national level identified several predictors of prolonged emergency department length of stay in Saudi Arabia, including shift time, season, severity level, and hospital type. These results underline the necessity of continuous monitoring and improvement efforts in emergency departments, in line with policy initiatives aiming to enhance patient outcomes in Saudi Arabia.
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Affiliation(s)
- Abdullah A. Alharbi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | | | - Mohammed A. Muaddi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahmad Y. Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Reem S. AlOmar
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Chen KCJ, Elliott CG, Nemnom MJ, Ouyang Y, Fitzpatrick T. The impact of learner involvement in emergency department patient assessments on short-term return visits requiring hospital admission: a cross-sectional study. CAN J EMERG MED 2022; 24:606-610. [PMID: 35666370 DOI: 10.1007/s43678-022-00325-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Learners, either medical students or residents, often perform the initial assessment of patients visiting the emergency department (ED). It is unclear, however, if learners affect the rate of short-term unscheduled return visits. The objective of this study was to determine if the involvement of learners in ED visits increases the rate of return visits. METHODS This was a retrospective cross-sectional analysis of ED visit data at a single tertiary care centre over a 1-year period. Return visits were defined as those presenting within 72 h of discharge from an initial non-admit ED visit and resulting in an admission on the second visit. A generalized linear mixed model was used to determine the odds ratios of return visits, adjusting for prespecified co-variates, with and without learners involved during the initial visit. Secondary analyses assessed for associations between learner level of training, program of study and return visits. RESULTS Return visits occurred after 658 (1.3%) of 51,149 encounters involving learners and 701 (0.8%) of 83,310 encounters with no learner involvement. Involvement of learners in ED initial visits was not associated with increased odds of return visits (adjusted OR 1.13 [95% CI 0.71-1.81]), although the point estimates were heterogeneous over learner level of training, with clerkship students (medical student years 3 and 4) and senior residents (post-graduate years 4 and 5) trending towards reduced odds of a return visit. Resident program of study did not independently predict return visits. CONCLUSIONS This study demonstrated that the involvement of learners in ED patient assessments is not associated with increased odds of short-term unscheduled return visits.
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Affiliation(s)
- Kuan-Chin Jean Chen
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Christopher G Elliott
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Yongdong Ouyang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tania Fitzpatrick
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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4
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Egan HM, Swanson MB, Ilko SA, Pomeranz KA, Mohr NM, Ahmed A. High-efficiency Practices of Residents in an Academic Emergency Department: A Mixed-methods Study. AEM EDUCATION AND TRAINING 2021; 5:e10517. [PMID: 34027282 PMCID: PMC8122129 DOI: 10.1002/aet2.10517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Emergency department utilization and crowding is increasing, putting additional pressure on emergency medicine (EM) residency programs to train efficient residents who can meet these demands. Specific practices associated with resident efficiency have yet to be identified. The objective of this study was to identify practices associated with enhanced efficiency in EM residents. METHODS A mixed-methods study design was utilized to identify behaviors associated with resident efficiency. In Stage 1, eight EM faculty provided 61 efficiency behaviors during semistructured interviews, which were prioritized into eight behaviors by independent ranking. A total of 31 behaviors were tested, including additions from previous literature and the study team. In Stage 2, two 4-hour observations during separate shifts of 27 EM residents were performed to record minute-by-minute timing and frequency of each behavior. In Stage 3, the association between resident efficiency and each of the behaviors was estimated using multivariable regression models adjusted for training year and clustered on resident. The primary efficiency outcome was 6-month average relative value units/hour. A sensitivity analysis was performed using patients/hour. RESULTS Seven practices were positively associated with efficiency: average patient load, taking initial patient history with nurse present (number/hour, number/new patient), running the board (number/hour), conversations with other care team members (number/hour, % time), dictation use (number/hour, % time), smartphone text communication (number/hour, % time), and nonwork tasks (number/hour). Three practices were negatively associated with efficiency: visits to patient room (number/patient), conversations with attending physicians (% time), and reviewing electronic medical record (number/hour). CONCLUSION Several discrete behaviors were found to be associated with enhanced resident efficiency. These results can be utilized by EM residency programs to improve resident education and inform evaluations by providing specific, evidence-based practices for residents to develop and improve upon throughout training.
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Affiliation(s)
- Haley M. Egan
- Roy A. and Lucille J. Carver College of MedicineUniversity of IowaIowa CityIAUSA
| | - Morgan B. Swanson
- Roy A. and Lucille J. Carver College of MedicineUniversity of IowaIowa CityIAUSA
- Department of EpidemiologyCollege of Public HealthUniversity of IowaIowa CityIAUSA
| | - Steven A. Ilko
- Roy A. and Lucille J. Carver College of MedicineUniversity of IowaIowa CityIAUSA
| | - Kaila A. Pomeranz
- Department of Emergency MedicineCollege of Public HealthUniversity of IowaIowa CityIAUSA
| | - Nicholas M. Mohr
- Department of EpidemiologyCollege of Public HealthUniversity of IowaIowa CityIAUSA
- Department of AnesthesiaDivision of Critical CareUniversity of IowaIowa CityIAUSA
| | - Azeemuddin Ahmed
- Department of Emergency MedicineCollege of Public HealthUniversity of IowaIowa CityIAUSA
- Tippie College of BusinessUniversity of IowaIowa CityIAUSA
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Doctor K, Breslin K, Chamberlain JM, Berkowitz D. Practice Pattern Variation in Test Ordering for Low-Acuity Pediatric Emergency Department Patients. Pediatr Emerg Care 2021; 37:e116-e123. [PMID: 30335687 DOI: 10.1097/pec.0000000000001637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Rising costs in healthcare have focused attention on interventions to optimize efficiency of patient care, including decreasing unnecessary diagnostic testing. The primary objective of this study was to determine the variability of laboratory and radiology testing among licensed independent providers (LIPs) with different training backgrounds treating low-acuity patients in a pediatric emergency department (PED). METHODS We performed a retrospective review of the electronic health records of all encounters with patients 21 years or younger, triaged as low-acuity, visiting 2 urban, academic PEDs from January 2012 to December 2013. We calculated frequency of orders for specific tests, including complete blood counts, aerobic blood cultures, urine cultures, and chest radiographs. Bivariable analyses were used to measure associations of test ordering between these LIP dyad groups: physician versus nurse practitioner (NP); physicians with pediatric emergency medicine fellowship training (PEM) versus physicians without PEM training and physicians with at least 5 years since residency graduation versus less than 5 years. We used multivariable logistic regression to adjust for potential confounders, including ED location, trainee co-management, and patient characteristics. We also performed sensitivity analyses by location. RESULTS There were 148,570 total encounters treated by 12 NPs and 144 physicians, of whom 60 were PEM physicians. Seventy-three physicians had 5 or more years of experience. Testing rates per patient encounter ranged from 0% to 40% for individual providers. In bivariable analyses, testing was more likely when the LIP was a physician (odds ratio [OR] = 1.2, 95% confidence interval = 1.1-1.2) or PEM trained (OR = 1.3, 1.2-1.3). In multivariable analyses, testing was more likely for encounters with PEM providers (adjusted OR [AdjOR] = 1.2, 1.1-1.3). A sensitivity analysis on a subset of encounters seen exclusively at our PED-based urgent care revealed that testing was also more likely for encounters seen by PEM physicians (AdjOR = 1.5, 1.4-1.7) and with NPs (AdjOR = 1.2, 1.1-1.4) compared with physicians. CONCLUSIONS Our study identified substantial variation in test ordering patterns for LIPs treating low-acuity patients. There were significant differences in ordering practices between providers from different training backgrounds, most significantly when comparing PEM with non-PEM providers. Further research should examine interventions to standardize practice across disciplines.
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Fouquet SD, Fitzmaurice L, Chan YR, Palmer EM. Doctors documenting: an ethnographic and informatics approach to understanding attending physician documentation in the pediatric emergency department. J Am Med Inform Assoc 2021; 28:239-248. [PMID: 33175154 DOI: 10.1093/jamia/ocaa252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The pediatric emergency department is a highly complex and evolving environment. Despite the fact that physicians spend a majority of their time on documentation, little research has examined the role of documentation in provider workflow. The aim of this study is to examine the task of attending physician documentation workflow using a mixed-methods approach including focused ethnography, informatics, and the Systems Engineering Initiative for Patient Safety (SEIPS) model as a theoretical framework. MATERIALS AND METHODS In a 2-part study, we conducted a hierarchical task analysis of patient flow, followed by a survey of documenting ED providers. The second phase of the study included focused ethnographic observations of ED attendings which included measuring interruptions, time and motion, documentation locations, and qualitative field notes. This was followed by analysis of documentation data from the electronic medical record system. RESULTS Overall attending physicians reported low ratings of documentation satisfaction; satisfaction after each shift was associated with busyness and resident completion. Documentation occurred primarily in the provider workrooms, however strategies such as bedside documentation, dictation, and multitasking with residents were observed. Residents interrupted attendings more often but also completed more documentation actions in the electronic medical record. DISCUSSION Our findings demonstrate that complex work processes such as documentation, cannot be measured with 1 single data point or statistical analysis but rather a combination of data gathered from observations, surveys, comments, and thematic analyses. CONCLUSION Utilizing a sociotechnical systems framework and a mixed-methods approach, this study provides a holistic picture of documentation workflow. This approach provides a valuable foundation not only for researchers approaching complex healthcare systems but also for hospitals who are considering implementing large health information technology projects.
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Affiliation(s)
- Sarah D Fouquet
- Human Factors Collaborative, Children's Mercy Hospital Kansas City, Kansas City, Missouri, USA.,Department of Biomedical and Health Informatics, University of Missouri, Kansas City, Missouri, USA
| | - Laura Fitzmaurice
- Department of Emergency Medicine, Children's Mercy Hospital Kansas City, Kansas City, Missouri, USA
| | - Y Raymond Chan
- Human Factors Collaborative, Children's Mercy Hospital Kansas City, Kansas City, Missouri, USA.,Division of Hospital Medicine, Children's Mercy Hospital Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri, Kansas City, Missouri, USA
| | - Evan M Palmer
- Department of Psychology, San José State University, San José, California, USA
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7
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Jenkins D, Pathan S, Moinudheen J, Qureshi R, Qureshi I, Farook S, Thomas S. The Impact of On-duty Emergency Medicine Trainees on Left-Without-Being-Seen Rates in an Academic Emergency Department. Qatar Med J 2020; 2020:7. [PMID: 32257881 PMCID: PMC7109545 DOI: 10.5339/qmj.2020.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/23/2019] [Indexed: 11/12/2022] Open
Abstract
Objectives: One of the endpoints for assessing the emergency department (ED) performance is the left-without-being-seen (LWBS) proportion. This study aimed to evaluate the impact of increasing proportions of on-duty emergency medicine (EM) trainees on LWBS rates in clinical shifts. Methods: The study was conducted at an urban-academic-ED (annual census: 452,757) over a period of one year. We employed multivariate linear regression (p < 0.05) defining significance to identify and adjust for multiple LWBS influencers related to patient care. Results: After analyzing over 1098 shifts, the median LWBS rate was 8.9% (interquartile range 5.3% to 13.5%). The increasing number of EM trainees in the ED did not adversely impact the LWBS; the opposite was noted. In univariate analysis, the increasing proportion of on-duty EM trainee physicians was significantly (p < 0.001) associated with a decrease in the LWBS rates. The multivariate model adjusted for the statistically significant and confounding LWBS influencers, with an absolute increase of 1% in trainees’ proportion of overall on-duty physician coverage, was associated with an absolute decrease of 2.1% in LWBS rates (95% confidence interval 0.43% to 3.8%, p = 0.014). Conclusions: At the study site, there was a statistically and operationally significant improvement in LWBS associated with partial replacement of board-certified specialist-grade EM physicians with EM residents and fellow trainees.
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8
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Malhotra T, Thomas S, Arora KS. Impact of Medical Students on Patient Satisfaction of Pregnant Women in Labor and Delivery Triage. Matern Child Health J 2020; 23:1467-1472. [PMID: 31214951 DOI: 10.1007/s10995-019-02771-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Clinical rotations are an important aspect of undergraduate medical education. However, as patient satisfaction scores receive increasing attention, the impact of medical student participation on patient satisfaction and perception of quality of care is unclear. Previous studies from the Emergency Department and outpatient settings show that medical students do not negatively impact satisfaction scores. The authors sought to examine the effect of medical student involvement on patient satisfaction in the Labor and Delivery Triage setting. METHODS The authors conducted a survey study of a convenience sample of pregnant patients seen in and discharged from Labor and Delivery between January 2015 and April 2016. Surveys addressed questions about the overall satisfaction with the care patients received, as well as other outcome measures such as comfort with asking questions, time spent with a physician, and politeness of staff. RESULTS 240 total surveys were collected. After excluding surveys from those that were unsure whether a medical student was involved in their care, 168 surveys were used in the final analysis. Of these, 63.7% of subjects reported being seen by a medical student. There was no significant difference (p = 0.76) in overall patient satisfaction between groups. CONCLUSIONS FOR PRACTICE Given the lack of a negative impact of medical student involvement on patient satisfaction, medical students should continue to be active members of the healthcare team, including in specialties such as obstetrics and locations such as Labor and Delivery triage with highly sensitive and time-dependent evaluations.
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Affiliation(s)
- Tani Malhotra
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, 2500 Metrohealth Dr., Cleveland, OH, 44109, USA.
| | - Stephanie Thomas
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, 2500 Metrohealth Dr., Cleveland, OH, 44109, USA
| | - Kavita S Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, 2500 Metrohealth Dr., Cleveland, OH, 44109, USA.,Case Western Reserve University, Cleveland, USA
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Robinson RD, Dib S, Mclarty D, Shaikh S, Cheeti R, Zhou Y, Ghasemi Y, Rahman M, Schrader CD, Wang H. Productivity, efficiency, and overall performance comparisons between attendings working solo versus attendings working with residents staffing models in an emergency department: A Large-Scale Retrospective Observational Study. PLoS One 2020; 15:e0228719. [PMID: 32023302 PMCID: PMC7001986 DOI: 10.1371/journal.pone.0228719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background and objective Attending physician productivity and efficiency can be affected when working simultaneously with Residents. To gain a better understanding of this effect, we aim to compare productivity, efficiency, and overall performance differences among Attendings working solo versus working with Residents in an Emergency Department (ED). Methods Data were extracted from the electronic medical records of all patients seen by ED Attendings and/or Residents during the period July 1, 2014 through June 30, 2017. Attending productivity was measured based on the number of new patients enrolled per hour per provider. Attending efficiency was measured based on the provider-to-disposition time (PDT). Attending overall performance was measured by Attending Performance Index (API). Furthermore, Attending productivity, efficiency, and overall performance metrics were compared between Attendings working solo and Attendings working with Residents. The comparisons were analyzed after adjusting for confounders via propensity score matching. Results A total of 15 Attendings and 266 Residents managing 111,145 patient encounters over the study period were analyzed. The mean (standard deviation) of Attending productivity and efficiency were 2.9 (1.6) new patients per hour and 2.7 (1.8) hours per patient for Attendings working solo, in comparison to 3.3 (1.9) and 3.0 (2.0) for Attendings working with Residents. When paired with Residents, the API decreased for those Attendings who had a higher API when working solo (average API dropped from 0.21 to 0.19), whereas API increased for those who had a lower API when working solo (average API increased from 0.13 to 0.16). Conclusion In comparison to the Attending working solo staffing model, increased productivity with decreased efficiency occurred among Attendings when working with Residents. The overall performance of Attendings when working with Residents varied inversely against their performance when working solo.
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Affiliation(s)
- Richard D. Robinson
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, United States of America
- University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Sasha Dib
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, United States of America
| | - Daisha Mclarty
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, United States of America
| | - Sajid Shaikh
- Department of Information Technology, John Peter Smith Health Network, Fort Worth, TX, United States of America
| | - Radhika Cheeti
- Department of Information Technology, John Peter Smith Health Network, Fort Worth, TX, United States of America
| | - Yuan Zhou
- Department of Industrial, Manufacturing, & Systems Engineering, The University of Texas at Arlington, Arlington, TX, United States of America
| | - Yasaman Ghasemi
- Department of Industrial, Manufacturing, & Systems Engineering, The University of Texas at Arlington, Arlington, TX, United States of America
| | - Mdmamunur Rahman
- Department of Industrial, Manufacturing, & Systems Engineering, The University of Texas at Arlington, Arlington, TX, United States of America
| | - Chet D. Schrader
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, United States of America
| | - Hao Wang
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, United States of America
- * E-mail:
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Kirby R, Robinson RD, Dib S, Mclarty D, Shaikh S, Cheeti R, Ho AF, Schrader CD, Zenarosa NR, Wang H. Emergency Medicine Resident Efficiency and Emergency Department Crowding. AEM EDUCATION AND TRAINING 2019; 3:209-217. [PMID: 31360813 PMCID: PMC6637007 DOI: 10.1002/aet2.10327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/05/2019] [Accepted: 01/08/2019] [Indexed: 06/10/2023]
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.
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Affiliation(s)
- Ryan Kirby
- Department of Emergency MedicineIntegrative Emergency ServicesJohn Peter Smith Health NetworkFort WorthTX
| | - Richard D. Robinson
- Department of Emergency MedicineIntegrative Emergency ServicesJohn Peter Smith Health NetworkFort WorthTX
- Department of Medical EducationUniversity of North Texas Health Science CenterFort WorthTX
| | - Sasha Dib
- Department of Emergency MedicineIntegrative Emergency ServicesJohn Peter Smith Health NetworkFort WorthTX
| | - Daisha Mclarty
- Department of Emergency MedicineIntegrative Emergency ServicesJohn Peter Smith Health NetworkFort WorthTX
| | - Sajid Shaikh
- Department of Information TechnologyJohn Peter Smith Health NetworkFort WorthTX
| | - Radhika Cheeti
- Department of Information TechnologyJohn Peter Smith Health NetworkFort WorthTX
| | - Amy F. Ho
- Department of Emergency MedicineIntegrative Emergency ServicesJohn Peter Smith Health NetworkFort WorthTX
| | - Chet D. Schrader
- Department of Emergency MedicineIntegrative Emergency ServicesJohn Peter Smith Health NetworkFort WorthTX
| | - Nestor R. Zenarosa
- Department of Emergency MedicineIntegrative Emergency ServicesJohn Peter Smith Health NetworkFort WorthTX
| | - Hao Wang
- Department of Emergency MedicineIntegrative Emergency ServicesJohn Peter Smith Health NetworkFort WorthTX
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11
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MacIntosh T, Lebowitz DC, Ganti L. Medical students and metrics: seven techniques for a win-win situation. Int J Emerg Med 2019; 12:13. [PMID: 31179935 PMCID: PMC6501299 DOI: 10.1186/s12245-019-0230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/03/2019] [Indexed: 11/17/2022] Open
Abstract
Background The authors present seven winning strategies for maintaining a rich academic environment for learners while working in a busy emergency department with expected productivity metrics. Methods This is a descriptive paper based on existing literature and on the authors’ experience. Results Winning strategies to improve ED throughput while also supporting the mission of medical education and improving the learning environment for students include the following: (1) attending first, (2) provider in triage, (3) mobile workstations, (4) patient education, (5) bedside patient presentations, (6) dedicated teaching resident, and (7) thoughtful scheduling. Conclusions The authors present seven practical strategies that are portable to many settings.
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Affiliation(s)
- Tracy MacIntosh
- Emergency Medicine, University of Central Florida, Orlando, FL, USA
| | - David C Lebowitz
- Emergency Medicine, University of Central Florida, Orlando, FL, USA
| | - Latha Ganti
- Emergency Medicine, University of Central Florida, Orlando, FL, USA.
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12
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Gupta T, Light A, Nandakumar M, Dadabhoy M, Burrows A, Daniel A. Medical students’ views of clinical environments. CLINICAL TEACHER 2018; 15:351. [DOI: 10.1111/tct.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tanya Gupta
- GKT School of Medical Education; King's College London; Guy's Campus; London UK
| | - Alexander Light
- GKT School of Medical Education; King's College London; Guy's Campus; London UK
| | - Madura Nandakumar
- GKT School of Medical Education; King's College London; Guy's Campus; London UK
| | - Maria Dadabhoy
- GKT School of Medical Education; King's College London; Guy's Campus; London UK
| | - Abigail Burrows
- GKT School of Medical Education; King's College London; Guy's Campus; London UK
| | - Allen Daniel
- GKT School of Medical Education; King's College London; Guy's Campus; London UK
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Chiu IM, Syue YJ, Kung CT, Cheng FJ, Lee CH, Lin YR, Li CJ. The influence of resident seniority on supervised practice in the emergency department. Medicine (Baltimore) 2017; 96:e5987. [PMID: 28121953 PMCID: PMC5287977 DOI: 10.1097/md.0000000000005987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the influence of resident seniority on supervised clinical practice in the emergency department (ED).This was a retrospective, 1-year cohort study conducted in 5 EDs within Taiwan largest healthcare system. All adult nontrauma visits presenting to the EDs during the day shift between July 1, 2011 and June 30, 2012 were included in the analysis. Visits were divided into supervised (ie, treated by resident under attending physician's supervision) and attending-alone. Supervised visits were further categorized by resident seniority (junior, intermediate, and senior). The decision-making time (door-to-order and door-to-disposition time), patient dispositions (eg, ED observation and hospital admission), and diagnostic tool use (laboratory examination or computed tomography [CT]) were selected as clinical performance indicators. The differences in clinical performance were determined between supervised visits (ie, resident-seniority groups) and attending-alone visits.Junior residents were found to have longer median door-to-order and door-to-disposition time than were the other residents for urgent and nonurgent patients. Furthermore, compared with attending-alone visits, supervised visits with junior residents had a greater odds of ED observation (adjusted odds ratio [aOR], 1.1; 95% CI, 1.07-1.20), while supervised visits with all 3 resident-seniority groups had significantly greater odds of laboratory examinations (junior: aOR, 1.1; 95% CI, 1.03-1.16; intermediate: aOR, 1.1; 95% CI, 1.04-1.15; and senior: aOR, 1.1; 95% CI, 1.05-1.15).As resident seniority increases, less time is needed for decision making in supervised visits. However, compared to attending-alone visits, supervised visits still resulted in greater use of laboratory examinations and delayed patient disposition.
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Affiliation(s)
- I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Jhen Syue
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hung Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yan-Ren Lin
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chao-Jui Li
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Shepherd L, Chahine S, Klingel M, Zibrowski E, Meiwald A, Lingard L. Reducing length of stay and satisfying learner needs. PERSPECTIVES ON MEDICAL EDUCATION 2016; 5:170-178. [PMID: 27246966 PMCID: PMC4908043 DOI: 10.1007/s40037-016-0276-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A complicated relationship exists between emergency department (ED) learner needs and patient flow with solutions to one issue often negatively affecting the other. Teaching shifts that allow clinical teachers and learners to interact without the pressure of patient care may offer a mutually beneficial solution. This study investigated the relationship between teaching shifts on ED length of stay, student self-efficacy and knowledge application.In 2012-2013, a prospective, cohort study was undertaken in a large Canadian acute-care teaching centre. All 132 clinical clerks completing their mandatory two-week emergency medicine rotation participated in three teaching shifts supervised by one faculty member without patient care responsibilities. The curriculum emphasized advanced clinical skills and included low fidelity simulation exercises, a suturing lab, image interpretation modules and discussion about psychosocial issues in emergency medicine. The clerks then completed seven clinical shifts in the traditional manner caring for patients under the supervision of an ED attending physician. Length of stay was compared during and one week following teaching shifts. A self-efficacy questionnaire was validated through exploratory factor analysis. Pre/post knowledge application was assessed using a paper-based clinical case activity.Across 40.998 patient visits, median length of stay was shortened overall by 5 minutes (95 % CI:1.2, 8.8) when clerks were involved in their teaching shifts. In the first academic block, median length of stay was reduced by 20 minutes per patient (95 % CI:12.7, 27.3). Self-efficacy showed significant improvement post teaching shifts (p < 0.001) with large effect sizes (d > 1.25) on dimensions of knowledge base, suturing, trauma and team efficacy. Students' knowledge application scores improved from pre to post (p < 0.01), with notable gains in the generation of differential diagnoses.Teaching shifts are an effective educational intervention that has a positive relation to ED patient flow while successfully attending to learner needs. Teaching shifts for the most naïve clerks in the first academic block appear to maximally benefit length of stay. Students demonstrated improved self-efficacy and knowledge application after their teaching shifts.
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Affiliation(s)
- Lisa Shepherd
- Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| | - Saad Chahine
- Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Michelle Klingel
- Division of Emergency Medicine, Department of Medicine, Western University, London, Ontario, Canada
| | - Elaine Zibrowski
- Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Allison Meiwald
- Division of Emergency Medicine, Department of Medicine, Western University, London, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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15
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Clinkscales JD, Fesmire FM, Hennings JR, Severance HW, Seaberg DC, Patil N. The Effect of Emergency Medicine Residents on Clinical Efficiency and Staffing Requirements. Acad Emerg Med 2016; 23:78-82. [PMID: 26714030 DOI: 10.1111/acem.12834] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/25/2015] [Accepted: 05/06/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The effect of emergency medicine (EM) residents on the clinical efficiency of attending physicians is controversial. The authors hypothesized that implementing a new EM residency program would result in an increase in relative value units (RVUs) generated per hour by attending physicians and decrease staffing requirements. METHODS This was a retrospective observational analysis of an emergency department before, during, and after the establishment of a new EM residency program. We analyzed the change in RVUs billed, patients seen, and hours worked by attending physicians, midlevel providers (MLPs), and residents, and addressed potential confounding factors. RESULTS The clinical efficiency of attending physicians increased by 70%, or 4.98 RVUs/hour (from 7.12 [SD ± 1.4] RVUs/hour to 12.1 [SD ± 2.2] RVUs/hour, p < 0.001) with the implementation of an EM residency program. Overall, net department RVU generation rose by 32%, even as attending physician coverage decreased by 6.3% (p < 0.05), and MLP coverage dropped by 60% (p < 0.05). We estimated that the implementation of the residency saved 4,860 hours of attending physician coverage and 5,828 hours of MLP coverage per year. This represents an estimated $1,741,265 in annual staffing savings, comparable to the residency program's annual operating cost of $1,821,108. CONCLUSIONS The implementation of an EM residency program had a positive effect on the clinical efficiency of attending physicians and decreased staffing requirements.
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Affiliation(s)
- Jeffrey D. Clinkscales
- Department of Emergency Medicine; Erlanger Institute for Clinical Research; University of Tennessee College of Medicine Chattanooga; Erlanger Health System; Chattanooga TN
| | - Francis M. Fesmire
- Department of Emergency Medicine; Erlanger Institute for Clinical Research; University of Tennessee College of Medicine Chattanooga; Erlanger Health System; Chattanooga TN
| | - Jacob R. Hennings
- Department of Emergency Medicine; Erlanger Institute for Clinical Research; University of Tennessee College of Medicine Chattanooga; Erlanger Health System; Chattanooga TN
| | - Harry W. Severance
- Department of Emergency Medicine; Erlanger Institute for Clinical Research; University of Tennessee College of Medicine Chattanooga; Erlanger Health System; Chattanooga TN
| | - David C. Seaberg
- Department of Emergency Medicine; Erlanger Institute for Clinical Research; University of Tennessee College of Medicine Chattanooga; Erlanger Health System; Chattanooga TN
| | - Nirav Patil
- Department of Quality Management; Greenville Health System; Greenville SC
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16
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Kiefer C, Turner JS, Layman SM, Davis SM, Besinger BR, Humbert A. Introducing Medical Students into the Emergency Department: The Impact upon Patient Satisfaction. West J Emerg Med 2015; 16:894-8. [PMID: 26594286 PMCID: PMC4651590 DOI: 10.5811/westjem.2015.9.27255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/04/2015] [Accepted: 09/26/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Performance on patient satisfaction surveys is becoming increasingly important for practicing emergency physicians and the introduction of learners into a new clinical environment may impact such scores. This study aimed to quantify the impact of introducing fourth-year medical students on patient satisfaction in two university-affiliated community emergency departments (EDs). Methods Two community-based EDs in the Indiana University Health (IUH) system began hosting medical students in March 2011 and October 2013, respectively. We analyzed responses from patient satisfaction surveys at each site for seven months before and after the introduction of students. Two components of the survey, “Would you recommend this ED to your friends and family?” and “How would you rate this facility overall?” were selected for analysis, as they represent the primary questions reviewed by the Center for Medicare Services (CMS) as part of value-based purchasing. We evaluated the percentage of positive responses for adult, pediatric, and all patients combined. Results Analysis did not reveal a statistically significant difference in the percentage of positive response for the “would you recommend” question at both clinical sites with regards to the adult and pediatric subgroups, as well as the all-patient group. At one of the sites, there was significant improvement in the percentage of positive response to the “overall rating” question following the introduction of medical students when all patients were analyzed (60.3% to 68.2%, p=0.038). However, there was no statistically significant difference in the “overall rating” when the pediatric or adult subgroups were analyzed at this site and no significant difference was observed in any group at the second site. Conclusion The introduction of medical students in two community-based EDs is not associated with a statistically significant difference in overall patient satisfaction, but was associated with a significant positive effect on the overall rating of the ED at one of the two clinical sites studied. Further study is needed to evaluate the effect of medical student learners upon patient satisfaction in settings outside of a single health system.
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Affiliation(s)
- Christopher Kiefer
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Joseph S Turner
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Shelley M Layman
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Stephen M Davis
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Bart R Besinger
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Aloysius Humbert
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
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Bernard AW, Martin DR, Moseley MG, Kman NE, Khandelwal S, Carpenter D, Way DP, Caterino JM. The Impact of Medical Student Participation in Emergency Medicine Patient Care on Departmental Press Ganey Scores. West J Emerg Med 2015; 16:830-8. [PMID: 26594274 PMCID: PMC4651578 DOI: 10.5811/westjem.2015.9.27321] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/16/2015] [Accepted: 09/26/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction Press Ganey (PG) scores are used by public entities to gauge the quality of patient care from medical facilities in the United States. Academic health centers (AHCs) are charged with educating the new generation of doctors, but rely heavily on PG scores for their business operation. AHCs need to know what impact medical student involvement has on patient care and their PG scores. Purpose We sought to identify the impact students have on emergency department (ED) PG scores related to overall visit and the treating physician’s performance. Methods This was a retrospective, observational cohort study of discharged ED patients who completed PG satisfaction surveys at one academic, and one community-based ED. Outcomes were responses to questions about the overall visit assessment and doctor’s care, measured on a five-point scale. We compared the distribution of responses for each question through proportions with 95% confidence intervals (CIs) stratified by medical student participation. For each question, we constructed a multivariable ordinal logistic regression model including medical student involvement and other independent variables known to affect PG scores. Results We analyzed 2,753 encounters, of which 259 (9.4%) had medical student involvement. For all questions, there were no appreciable differences in patient responses when stratifying by medical student involvement. In regression models, medical student involvement was not associated with PG score for any outcome, including overall rating of care (odds ratio [OR] 1.10, 95% CI [0.90–1.34]) or likelihood of recommending our EDs (OR 1.07, 95% CI [0.86–1.32]). Findings were similar when each ED was analyzed individually. Conclusion We found that medical student involvement in patient care did not adversely impact ED PG scores in discharged patients. Neither overall scores nor physician-specific scores were impacted. Results were similar at both the academic medical center and the community teaching hospital at our institution.
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Affiliation(s)
- Aaron W Bernard
- Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, Connecticut
| | - Daniel R Martin
- Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Mark G Moseley
- Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Nicholas E Kman
- Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Sorabh Khandelwal
- Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Daniel Carpenter
- Ohio State University, Department of Biomedical Informatics, Columbus, Ohio
| | - David P Way
- Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Jeffrey M Caterino
- Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
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Abstract
: Experience and available research suggest that Developmental Behavioral Pediatric (DBP) practice is both complex and variable. Variability involves multiple aspects of DBP care, from activities before the visit (e.g. triage and collecting information) to activities during (e.g. history taking and testing) and after the visit (e.g. care coordination). Together these activities represent workflow, a series of clinical events by which health care is delivered. In complex systems, workflow variation often suggests the presence of inefficiency or inconsistent quality. Given the current environment of increasing health care costs and an increasing focus on quality, DBP practitioners must be mindful of these concepts for the field of DBP to remain viable. In order to characterize current DBP practice and identify common challenges, a workshop was developed with the ultimate goal of identifying potential solutions for improving both quality and efficiency. This paper summarizes the workshop findings and proposes future directions to foster improvements in DBP workflow.
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Nicks BA, Mahler S, Manthey D. Impact of a physician-in-triage process on resident education. West J Emerg Med 2014; 15:902-7. [PMID: 25493151 PMCID: PMC4251252 DOI: 10.5811/westjem.2014.9.22859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/24/2014] [Accepted: 09/02/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Emergency department (ED) crowding negatively impacts patient care quality and efficiency. To reduce crowding many EDs use a physician-in-triage (PIT) process. However, few studies have evaluated the effect of a PIT processes on resident education. Our objective was to determine the impact of a PIT process implementation on resident education within the ED of an academic medical center. METHODS We performed a prospective cross-sectional study for a 10-week period from March to June 2011, during operationally historic trended peak patient volume and arrival periods. Emergency medicine residents (three-year program) and faculty, blinded to the research objectives, were asked to evaluate the educational quality of each shift using a 5-point Likert scale. Residents and faculty also completed a questionnaire at the end of the study period assessing the perceived impact of the PIT process on resident education, patient care, satisfaction, and throughput. We compared resident and attending data using Mann-Whitney U tests. RESULTS During the study period, 54 residents and attendings worked clinically during the PIT process with 78% completing questionnaires related to the study. Attendings and residents indicated "no impact" of the PIT process on resident education [median Likert score of 3.0, inter-quartile range (IQR): 2-4]. There was no difference in attending and resident perceptions (p-value =0.18). Both groups perceived patient satisfaction to be "positively impacted" [4.0, IQR:2-4 for attendings vs 4.0, IQR:1-5 for residents, p-value =0.75]. Residents perceived more improvement in patient throughput to than attendings [3.5, IQR:3-4 for attendings vs 4.0, IQR:3-5 for residents, p-value =0.006]. Perceived impact on differential diagnosis generation was negative in both groups [2.0, IQR:1-3 vs 2.5, IQR:1-5, p-value = 0.42]. The impact of PIT on selection of diagnostic studies and medical decision making was negative for attendings and neutral for residents: [(2.0, IQR:1-3 vs 3.0, IQR:1-4, p-value =0.10) and (2.0, IQR:1-4 vs 3.0, IQR:1-5, p-value =0.14 respectively]. CONCLUSION Implementation of a PIT process at an academic medical center was not associated with a negative (or positive) perceived impact on resident education. However, attendings and residents felt that differential diagnosis development was negatively impacted. Attendings also felt diagnostic test selection and medical decision-making learning were negatively impacted by the PIT process.
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Affiliation(s)
- Bret A. Nicks
- Wake Forest University Health Sciences, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - Simon Mahler
- Wake Forest University Health Sciences, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - David Manthey
- Wake Forest University Health Sciences, Department of Emergency Medicine, Winston-Salem, North Carolina
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