Abstract
BackgroundDifferences in productivity between off-service residents rotating in the emergency department (ED) and their emergency medicine (EM) resident counterparts have never been directly quantified. ObjectivesWe sought to quantify the difference between off-service residents rotating in the ED and their EM resident counterparts. We also sought to find whether shift cards could be used to increase the productivity of off-service residents rotating in the ED. MethodsThis is a prospective cohort study conducted at an urban, tertiary, Level I trauma center. We implemented the use of shift cards for off-service residents during their EM rotation. Completion of the shift card involved recording patients seen and their dispositions, procedures done, and documenting a learned bedside teaching point from their shift that day. Productivity was measured in terms of patients seen per hour (PPH) and relative value units per hour (RVU/h). ResultsOff-service residents showed a productivity of 0.529 PPH (95% confidence interval [CI] 0.493–0.566) and 1.40 RVU/h (95% CI 1.28–1.53) prior to implementation of shift cards. With the introduction of shift cards, productivity increased to 0.623 PPH (95% CI 0.584–0.663, p = 0.001) and 1.77 RVU/h (95% CI 1.64–1.91, p = 0.001). In comparison, first year EM resident productivity was 0.970 PPH (95% CI 0.918–1.02) and 3.01 RVU/h (95% CI 2.83–3.19). ConclusionsShift cards can be used to foster motivation for off-service residents rotating in the ED, and is a simple and cost-effective method to improve system-based practices and utilization of resources.
Highlights
Emergency medicine (EM) has traditionally been a rotation where off-service residents gain important clinical experience through month-long rotations [1]
When correcting for Emergency Departments (EDs) patient volume, off-service residents showed a productivity of 0.529 patients seen per hour (PPH) (95% confidence interval [CI] 0.493–0.566) and 1.40 relative value units per hour (RVU/h) prior to implementation of shift cards
Productivity increased to 0.623 PPH and 1.77 Relative value units (RVUs)/h after the implementation of shift cards (Figures 2 and 3)
Summary
Emergency medicine (EM) has traditionally been a rotation where off-service residents gain important clinical experience through month-long rotations [1]. In the face of declining Medicare reimbursement, graduate medical education funding is struggling to provide for an appropriate physician workforce without bankrupting teaching hospitals [2]. Many EM programs have had difficulty with funding off-service rotations and many have had decreased numbers of off-service residents in their Emergency Departments (EDs) [3]. Experts predict that EDs will see a flood of new patients when the Medicaid expansion provisions go into effect, especially in communities with large uninsured populations [4]. It is imperative that EM programs make efforts to ensure that off-service residents are properly utilized and have an adequate amount of experience for their training. Differences in productivity between off-service residents and EM residents within the same institution have not previously been quantified, RECEIVED: 17 December 2013; FINAL SUBMISSION RECEIVED: 15 August 2014; ACCEPTED: 10 November 2014
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