Impact of Medical Residency Programs on Emergency Department Efficiency

TL;DR

This study finds that emergency departments with medical residency programs have longer patient processing times but similar clinical outcomes compared to those staffed only by attending physicians.

Contribution

The study provides empirical evidence on the impact of medical residency programs on ED efficiency and clinical outcomes.

Findings

EDs with residency programs had significantly longer clinical process times for all measured variables.

Clinical outcomes such as discharge, admission, and death rates were similar between the two ED types.

Residency programs may delay care but do not appear to affect patient outcomes.

Abstract

Background and Objectives: Medical residency programs play a crucial role in emergency departments (EDs). However, clinical processes may differ between EDs staffed with medical residents and those staffed only by attending physicians. This study aims to compare clinical process times and clinical outcomes between these two types of EDs. Materials and Methods: A retrospective observational study was conducted, analyzing patients aged ≥ 18 years who visited an ED with a medical residency program and an ED staffed only by attending physicians. Time variables, including the time to first physician encounter, first order, CT order, consultation request, consulted specialist arrival, disposition decision, ED length of stay (LOS), and ED dispositions were compared between the two ED settings. Results: A total of 24,942 patients in an ED with a medical residency program and 19,867 patients in an ED staffed only by attending physicians were included in the final analysis. The ED with a medical residency program exhibited significantly longer times in all time variables including time to first physician encounter (7.0 [4.0–12.0] vs. 3.0 [1.0–5.0] min), first order (15.0 [9.0–23.0] vs. 9.0 [5.0–13.0] min), consultation request (95.0 [42.0–146.0] vs. 72.0 [27.0–124.0] min), consulted specialist arrival (156.0 [90.0–238.0] vs. 117.0 [63.0–176.0] min), and disposition decision (134.0 [70.0–208.0] vs. 92.0 [32.0–139.0] min). However, the proportion of discharges, admissions, and deaths were similar between the two EDs. Conclusions: The ED with a medical residency program may contribute to delays in clinical processing times; however, it appears to have no significant impact on clinical outcomes.

Figures