EducationThe Impact of Emergency Department Overcrowding on Resident Education
Introduction
Emergency Department (ED) overcrowding has been called a crisis in Emergency Medicine (EM) (1). ED overcrowding occurs when the demand for services overwhelms available resources. Symptoms of ED overcrowding include boarding admitted patients, diverting ambulances, and caring for patients on stretchers in hallways. As evidence to the magnitude of this problem, the Institute of Medicine has estimated that over 90% of EDs are affected by overcrowding (1). However, overcrowding is most severe in academic centers and urban hospitals, many of which support EM residency training programs 1, 2, 3.
Several studies have demonstrated that ED overcrowding is associated with increased morbidity and mortality 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. However, the impact of ED overcrowding on EM resident education is largely unknown. Several authors have hypothesized that overcrowding increases ED attendings’ clinical and administrative workload, resulting in decreased quality and time available for teaching 14, 15, 16.
At present, only one published peer-reviewed study assessing the relationship between overcrowding and EM resident education exists. Pines et al. assessed the quality of teaching for residents and medical students during individual patient encounters (17). This study failed to find a correlation between the quality of education and ED overcrowding. Unfortunately, the study was powered to detect only very large differences in educational quality and did not measure the number of patients seen or number of procedures completed. Smaller, possibly important educational differences may have been detected if the study had been adequately powered. Therefore, the objective of this study is to determine the impact of ED overcrowding on EM resident education as measured by number of patients seen, number of procedures completed, and resident perception.
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Materials and Methods
A prospective cross-sectional study was performed over a 3-month period from March to May 2009 at Louisiana State University Health Sciences Center Shreveport (LSUHSC-S). LSUHSC-S is a tertiary care, level I trauma center, and an academic center. The ED has an annual volume of 60,000 patient visits per year and treats primarily uninsured or underinsured patients. It is also home to a 1- to 3-year EM residency program with 7 residents per year.
Second- and third-year EM residents, blinded to the
Results
During the 3-month study period from March 2009 to May 2009, second- and third-year residents worked a total of 236 shifts. Questionnaires were completed for 125 shifts, a response rate of 53% (125/236). Group O had 54 questionnaires and group N had 71. Second-year residents completed 75 questionnaires, compared to 50 by third-year residents (Table 1).
The median ambulance diversion time per shift for Group O was 5 h (interquartile range [IQR] 3–7) compared to 0 h (IQR 0) for group N (p <
Discussion
Due to a high prevalence of overcrowding in academic centers and urban hospitals with EM residency training programs, several authors have hypothesized that overcrowding decreases the quality and time available for teaching in the ED 1, 2, 3, 14, 15, 16. In this study, the residents’ perception of the overall educational value of each shift did not differ significantly based on overcrowding. However, during times of overcrowding, residents cared for fewer patients and completed fewer
Conclusions
During shifts with ED overcrowding, EM residents saw fewer patients and performed fewer procedures. However, residents’ opinion of the educational value of shifts did not differ significantly based on overcrowding. The long-term effects of overcrowding on EM resident education remain unknown. Future studies should assess educational value, number of patients cared for, and number of procedures completed over a longer time period. In addition, future studies should measure educational value
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Factors Affecting Emergency Department Crowding
2020, Emergency Medicine Clinics of North AmericaCitation Excerpt :In the academic setting, crowding poses significant challenges to learners at all levels. During times of high ED crowding, emergency medicine residents see fewer patients and perform fewer procedures46; with crowding sustained at high levels, there is enormous educational impact throughout the course of a residency.47 ED crowding is also the third most commonly reported source of dissatisfaction in a study of American emergency medicine residents’ well-being.48
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2016, Operations Research for Health CareCitation Excerpt :In more recent decades, overcrowding has become a primary concern for emergency departments (EDs) [1–4].
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