Original ContributionResident productivity as a function of emergency department volume, shift time of day, and cumulative time in the emergency department
Section snippets
Background
For emergency medicine (EM) residents, productivity (number of patients evaluated per hour) improves throughout training [1], [2], [3], [4], [5]. Whether resident productivity varies as a function of patient volume in the emergency department (ED) or whether productivity varies as a function of time of day the shift occurs has not been studied. Whether resident productivity varies as a function of accumulated time in the ED during the course of a given shift or based on level of training has
Methods
This is a retrospective chart review of patients evaluated in the ED by first- (PGY-1), second- (PGY-2), and third-year EM residents (PGY-3) in a 65,000-volume tertiary care center. None of the residents at the time of the study had previous postgraduate training beyond their EM residency. The institutional review board reviewed and approved the study protocol. All ED resident shifts during the study period were included. The period for the study was a 3-month period starting November 1, 2006.
Results
One hundred sixty-one PGY-1, 264 PGY-2 (101 twelve-hour shifts and 163 eight-hour shifts), and 193 PGY-3 shifts (156 twelve-hour shifts and 37 eight-hour shifts) met our inclusion criteria. PGY-1 residents saw a mean of 0.85 patients per hour on 12-hour shifts (95% CI, ±0.04). PGY-2 residents saw a mean of 1.13 patients per hour during the study (95% CI, ±0.03). PGY-3 residents saw a mean of 1.25 patients per hour during the study (95% CI, ±0.04). Emergency department volume ranged from 127 to
Discussion
Although there is a growing body of literature regarding resident productivity, it is unclear what factors beyond level of training contribute to productivity. Prior studies have established productivity figures similar to ours for resident productivity as a function of level of training [1], [2], [3], [4], [6]. These data make sense intuitively, for as residents increase their experience, they are able to handle multiple patients with more speed and confidence. However, there are many other
Limitations
There are several limitations to our study. We did not control for patient acuity because our tracking system lists a patient's chief complaint but does not assign an acuity value. Clearly, acuity level could influence productivity comparisons. It would be possible to control for this variable using a standardized acuity scale at the time of patient registration. We did not incorporate RVUs into productivity, which is also a limitation. However, RVU scores are highly dependent on patient length
Conclusions
Resident productivity is not strongly linked to patient volume or shift time of day at our institution. Based on our analysis, only PGY-1 residents can increase productivity in terms of patients per hour in response to departmental need, and even then, the relationship is weak. Rather than rely on residents to see more patients, if specific days of the week or times of the day are known statistically to have higher volume, those times should be staffed with a larger number of residents. Aside
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