Smalley Courtney M, Jacquet Gabrielle A, Sande Margaret K, Heard Kennon, Druck Jeffrey
Denver Health Residency in Emergency Medicine, Denver Health & Hospital Authority, Denver, Colorado.
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado.
West J Emerg Med. 2014 Mar;15(2):165-9. doi: 10.5811/westjem.2013.8.16316.
There are 161 emergency medicine residency programs in the United States, many of which have medical students rotating through the emergency department (ED). Medical students are typically supervised by senior residents or attendings while working a regular shift. Many believe that having students see and present patients prolongs length of stay (LOS), as care can be delayed. Our institution implemented a unique method of educating medical students while in the ED with the creation of a teaching service, whose primary goal is education in the setting of clinical care. The objective of this study was to explore the effect of the teaching service on efficiency by describing LOS and number of patients seen on shifts with and without a teaching service.
This was a retrospective chart review performed over a 12-month period of visits to an urban academic ED. We collected data on all patients placed in a room between 14:00 and 19:59, as these were the hours that the teaching shift worked in the department. We categorized shifts as 1) a teaching service with students (TWS); 2) a teaching service without students (TWOS); and 3) no teaching service (NTS). LOS and median number of patients seen on days with a teaching service, both with and without students (TWS and TWOS), was compared to LOS on days without a teaching service (NTS).
The median LOS on shifts with a dedicated teaching service without students (TWOS) was 206 minutes, while the median LOS on shifts with a teaching service with students (TWS) was 220 minutes. In comparison, the median LOS on shifts when no teaching service was present (NTS) was 202.5 minutes. The median number of patients seen on shifts with the teaching service with students (TWS) was 44, identical to the number seen on shifts when the teaching service was present without students (TWOS). When the teaching service was absent (NTS), the median number of patients seen was 40.
A teaching service in the ED is a novel educational model for medical student and resident instruction that increases total ED patient throughput and has only a modest effect on increased median length of stay for patients.
美国有161个急诊医学住院医师培训项目，其中许多项目都有医学生在急诊科轮转。医学生在正常轮班工作时通常由高年级住院医师或主治医生监督。许多人认为，让学生诊治和汇报患者会延长住院时间（LOS），因为诊治可能会延迟。我们机构通过创建一个教学服务部门，实施了一种在急诊科教育医学生的独特方法，其主要目标是在临床护理环境中进行教育。本研究的目的是通过描述有教学服务和无教学服务班次的住院时间和诊治患者数量，探讨教学服务对效率的影响。
这是一项对城市学术急诊科12个月就诊情况进行的回顾性病历审查。我们收集了14:00至19:59期间所有被安排在病房的患者的数据，因为这些是教学班次在该科室工作的时间。我们将班次分为：1）有学生的教学服务（TWS）；2）无学生的教学服务（TWOS）；3）无教学服务（NTS）。将有教学服务（无论有无学生，即TWS和TWOS）的日子里的住院时间和诊治患者中位数与无教学服务（NTS）的日子里的住院时间进行比较。
无学生的专门教学服务（TWOS）班次的住院时间中位数为206分钟，有学生的教学服务（TWS）班次的住院时间中位数为220分钟。相比之下，无教学服务（NTS）班次的住院时间中位数为202.5分钟。有学生的教学服务（TWS）班次诊治的患者中位数为44例，与有教学服务但无学生（TWOS）班次诊治的患者数量相同。无教学服务（NTS）时，诊治的患者中位数为40例。
急诊科的教学服务是一种针对医学生和住院医师教学的新型教育模式，可提高急诊科患者的总流量，对患者住院时间中位数的增加影响不大。
