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.
Acad Med. 2013 Nov;88(11):1723-31. doi: 10.1097/ACM.0b013e3182a7f1f8.
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.
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.
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.
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.
研究受训者对急诊科（ED）运作的影响得出了混合的结果。在这项研究中，作者评估了受训者对 ED 住院时间（LOS）、从门到医疗提供者（DTMP）时间和从门到处置决策（DTDD）时间的影响，同时考虑了已知会影响 ED 效率和及时性的协变量。
作者使用了缅因州医疗中心混合成人和儿科 ED 2005 年至 2009 年的门诊回顾性队列数据。每次就诊都根据进行就诊的提供者类型（学生主治医生、住院主治医生、中级提供者或主治医生组）进行编码。使用普通最小二乘法回归分析来检验提供者群体与 ED LOS、DTMP 时间和 DTDD 时间之间的关系。构建分层回归模型来控制分诊 acuity、一年中的时间、实验室检查、放射学检查和患者特征的混杂影响。
对 246142 次就诊的分析发现，在每个结果方面（P <.001），不同提供者群体之间存在显著的组间差异。多元回归模型显示，在控制协变量后，受训者的治疗是 LOS 延长（医学生和住院医师）、DTMP 时间缩短（住院医师）和 DTDD 时间延长（医学生和住院医师）的显著预测因素。
实验室和放射学检查对结果的变化解释了更大的比例，而受训者的作用则较小。LOS 和 DTDD 时间的小幅度增加被 DTMP 时间的减少和培训受训者的无形收益所平衡。
