Impact of Family Medicine Resident Physicians on Emergency Department Wait Times and Patients Leaving Without Being Seen

Abstract

Objective: To quantify the effect of family medicine resident physicians on emergency department (ED) wait times and patients leaving without being seen or treated. Methods: In a medium-volume community ED over twelve months, we used retrospective chart review to compare wait times between patients seen during shifts where staff were working alone versus with a resident. We measured the time from initial triage time to physician initial assessment (T 1 ) and disposition time (LOS), and number of patients leaving without being seen or treated. Results: In our analysis, 21,141 patients (91% of total visits) were included; 48% were in the staff-with-resident group, and 52% were in the staff-only group. Mean T 1 in the resident group was significantly shorter than the staff-only group (1 hour 23 minutes versus 1 hour 38 minutes, difference 15 minutes, 95% CI 13 to 17 minutes, p < 0.001). Mean total LOS in the resident group was also reduced (2 hours 38 minutes versus 2 hours 50 minutes, difference 12 minutes, 95% CI 8 to 17 minutes, p < 0.001). Fewer patients left without being seen in the resident group than the staff only group (2.8% versus 4.9%, p < 0.001). There were no differences in patients leaving without being treated (0.5% versus 0.5%). Conclusions: This is the first study to demonstrate that residents are associated with a reduction in ED wait times and patients leaving without being seen in a low-acuity, community hospital, compared to previous studies demonstrating no difference or increased wait times. RÉSUMÉObjectif: L'étude visait à quantifier l'effet des résidents en médecine familiale sur les délais d'attente aux services des urgences (SU) et sur le départ des patients sans avoir été vus ou traités. Méthode: Les auteurs ont procédé à un examen rétrospectif de dossiers médicaux ouverts dans un SU d'un hôpital communautaire de capacité moyenne, sur une période de 12 mois, pour comparer les délais d'attente des patients entre les périodes de travail où le personnel travaillait seul, sans résident, et celles où il travaillait avec un résident. Ont été calculés le temps écoulé depuis le moment du triage initial jusqu'à l'évaluation initiale par un médecin (T 1 ) et la durée de séjour (DS) quant aux suites à donner ainsi que le nombre de patients partis sans avoir été vus ou traités. Résultats: Dans l'ensemble, 21 141 patients (91 % de toutes les consultations) ont été inclus dans l'analyse; 48 % d'entre eux se sont trouvés dans le groupe du personnel accompagné de résidents, et 52 %, dans le groupe du personnel seul. Le T 1 moyen dans le groupe où il y avait des résidents était significativement plus court que celui dans le groupe où le personnel était seul (1 heure 23 minutes contre 1 heure 38 minutes; écart: 15 minutes; IC à 95 %: 13 à 17 minutes; p < 0,001). La durée totale moyenne de séjour était également plus courte dans le groupe de résidents que dans l'autre groupe (2 heures 38 minutes contre 2 heures 50 minutes; écart: 12 minutes; IC à 95 %: 8 à 17 minutes; p < 0,001). En outre, moins d...

Association of the Presence of Trainees With Outpatient Appointment Times in an Ophthalmology Clinic

“…One explanation for this finding is the theory of constraints, by which systems are often limited by a single bottleneck that determines overall efficiency . As has been stated by others, the bottleneck in an academic clinic is the physician, who must examine or review every patient before the appointment is over. If trainees affect the speed of the physician’s examination because of educational activities or if trainees delay the time at which the physician can examine the patient, their presence will affect the system as a whole.…”

Overcrowding in emergency departments: A review of strategies to decrease future challenges

“…[50] Wang and Vikram's research has shown that presence of a family medicine resident physician in ED is associated with reduced waiting time and patients leaving without being seen. [64] Hence, the team triage strategy through the participation of a physician as the leader could be one of the benchmarks.…”

Medical expertise as a critical influencing factor on the length of stay in the ED

“…[17] Few studies, however, have investigated caregiver factors and none that we are aware of have investigated the association between ED-LOS and physician specialty. [18,19] In Israel and many other countries where EM is still a relatively new specialty, there are insufficient residents and attending physicians to independently staff the ED 24 hours a day. [20] Thus, many EDs internationally are staffed by multidisciplinary teams consisting of EM physicians, internists and general surgeons along with a number of others staff roles.…”

“…Few studies, however, have investigated caregiver factors and none that we are aware of have investigated the association between ED-LOS and physician specialty [18,19] . In Israel and many other countries where EM is still a relatively new specialty, there are insufficient residents and attending physicians to independently staff the ED 24 hours a day [20] .…”