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The Effect of Medical Students and Residents on Measures of Efficiency and Timeliness in an Academic Medical Center Emergency Department

DeLaney, Matthew MD; Zimmerman, Kate D. DO; Strout, Tania D. PhD, RN, MS; Fix, Megan L. MD

doi: 10.1097/ACM.0b013e3182a7f1f8
Research Reports

Purpose Research regarding the effect of trainees on emergency department (ED) operations has demonstrated mixed results. In this study, the authors evaluated the effect of trainees on ED length of stay (LOS), door to medical provider (DTMP) time, and door to disposition decision (DTDD) time while accounting for covariates known to influence ED efficiency and timeliness.

Method The authors used retrospective cohort data for ED visits to Maine Medical Center’s mixed adult and pediatric ED for the calendar years 2005 through 2009. Each visit was coded indicating the type of provider conducting the visit (student–attending, resident–attending, midlevel provider, or attending group). Ordinary least squares regression analyses were performed to examine the relationships between provider groups and ED LOS, DTMP time, and DTDD time. Hierarchical regression models were constructed to control for the confounding effects of triage acuity, time of year, laboratory testing, radiographic testing, and patient characteristics.

Results The analysis of 246,142 visits found significant intergroup differences across provider groups for each outcome (P < .001). Multiple regression modeling revealed that treatment by trainees was a significant predictor of longer LOS (medical students and residents), shorter DTMP time (residents), and longer DTDD time (medical students and residents), after controlling for covariates.

Conclusions Laboratory and radiographic testing accounted for a much larger proportion of variation in outcomes than did trainees. The small increases in LOS and DTDD time are balanced by the decrease in DTMP time and the intangible benefits of educating trainees.

Dr. DeLaney is assistant professor of emergency medicine and assistant medical director, Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama.

Dr. Zimmerman is assistant professor of emergency medicine and medical student associate director, Department of Emergency Medicine, Maine Medical Center, Portland, Maine, and Tufts University School of Medicine, Boston, Massachusetts.

Dr. Strout is assistant professor of emergency medicine and research director, Department of Emergency Medicine, Maine Medical Center, Portland, Maine, and Tufts University School of Medicine, Boston, Massachusetts.

Dr. Fix is assistant professor of emergency medicine and associate program director, Division of Emergency Medicine, University of Utah Hospital, Salt Lake City, Utah

Funding/Support: None.

Other disclosures: None.

Ethical approval: The Maine Medical Center institutional review board approved this study.

Previous presentations: Material from this work was presented at the Society for Academic Emergency Medicine Annual Meeting, June 2011, Boston, Massachusetts, and the Council of Residency Directors Academic Assembly, March 2011, San Diego, California.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A158.

Correspondence should be addressed to Dr. Strout, Maine Medical Center, Department of Emergency Medicine, 22 Bramhall St., Portland, ME 04102; telephone: (207) 662-7049; fax: (207) 662-7054; e-mail: strout@mmc.org.

© 2013 by the Association of American Medical Colleges