Abstract
Objectives: One of the endpoints for assessing the emergency department (ED) performance is the left-without-being-seen (LWBS) proportion. This study aimed to evaluate the impact of increasing proportions of on-duty emergency medicine (EM) trainees on LWBS rates in clinical shifts. Methods: The study was conducted at an urban-academic-ED (annual census: 452,757) over a period of one year. We employed multivariate linear regression (p < 0.05) defining significance to identify and adjust for multiple LWBS influencers related to patient care. Results: After analyzing over 1098 shifts, the median LWBS rate was 8.9% (interquartile range 5.3% to 13.5%). The increasing number of EM trainees in the ED did not adversely impact the LWBS; the opposite was noted. In univariate analysis, the increasing proportion of on-duty EM trainee physicians was significantly (p < 0.001) associated with a decrease in the LWBS rates. The multivariate model adjusted for the statistically significant and confounding LWBS influencers, with an absolute increase of 1% in trainees’ proportion of overall on-duty physician coverage, was associated with an absolute decrease of 2.1% in LWBS rates (95% confidence interval 0.43% to 3.8%, p = 0.014). Conclusions: At the study site, there was a statistically and operationally significant improvement in LWBS associated with partial replacement of board-certified specialist-grade EM physicians with EM residents and fellow trainees.
Highlights
Over recent years, the government-operated healthcare system in the State of Qatar has evolved from a solely service-based organization to a recognized academic medical center status
This study aimed to evaluate the impact of increasing proportions of on-duty emergency medicine (EM) trainees on LWBS rates in clinical shifts
At the study site, there was a statistically and operationally significant improvement in LWBS associated with partial replacement of board-certified specialist-grade EM physicians with EM residents and fellow trainees
Summary
The government-operated healthcare system in the State of Qatar has evolved from a solely service-based organization to a recognized academic medical center status. Accreditation by the Joint Commission International group as an academic center has been accompanied by substantial evolution of the government’s major health provider, Hamad Medical Corporation (HMC). Changes in service model have been most pronounced at HMC’s (and the country’s) sole tertiary care center, Hamad General Hospital (HGH). The role of trainees in emergency medicine (EM) training programs, at the HGH ED, has grown from supernumerary ED positions to significant clinical care responsibilities. As of this year, trainees in the HGH Department of EM outnumber the SG physicians
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