Dehon Erin, McLemore Gerald, McKenzie L Kendall
From the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson.
South Med J. 2015 May;108(5):245-8. doi: 10.14423/SMJ.0000000000000264.
Emergency department (ED) overcrowding remains a growing concern despite continued efforts by hospitals to improve efficiency while also maintaining quality of care and medical education. The purpose of this study was to examine whether the total number of trainees rotating in the ED affects length of stay (LOS).
This was a single-center study conducted at an urban university teaching hospital and level I trauma center that averages 65,000 adult ED visits per year. Data were collected retrospectively during a 13-month period from September 2012 to September 2013. The mean daily LOS was generated by the hospital's electronic medical record system, and the total number of trainees (medical students, postgraduate year-1 students/interns, and nurse practitioners) rotating in the ED each day was collected from monthly shift calendars. Correlations were used to examine the relation between LOS and number of trainees rotating in the ED. Independent sample t tests were conducted to compare differences in average LOS on days with and without trainees rotating in the ED.
The mean daily LOS ranged from 3.39 to 7.13 hours (mean 4.97, standard deviation [SD] 0.59). The number of trainees rotating in the ED each day ranged from 0 to 11 (mean 5.32, SD 2.39). No significant relation was found between LOS and the number of trainees rotating in the ED (r = 0.06). Subsequent analyses using independent sample t test revealed that LOS did not vary even when no trainees were rotating in the ED (mean 4.93, SD 0.69) versus when at least one trainee was working (mean 4.97, SD 0.59).
Findings from this study suggest that ED LOS is unaffected by the presence or total number of trainees (medical students, postgraduate year-1 students/interns, and nurse practitioners) rotating in the ED. Further research is needed to examine what, if any, adjustments are being made to accommodate trainees and whether the quality of education suffers when the trainee-to-attending ratio is high.
尽管医院不断努力提高效率，同时维持医疗质量和医学教育，但急诊科过度拥挤仍是一个日益严重的问题。本研究的目的是探讨在急诊科轮转的实习医生总数是否会影响住院时间（LOS）。
这是一项在城市大学教学医院和一级创伤中心进行的单中心研究，该医院每年平均有65000例成人急诊就诊。数据于2012年9月至2013年9月的13个月期间进行回顾性收集。平均每日住院时间由医院的电子病历系统生成，每天在急诊科轮转的实习医生（医学生、研究生一年级学生/实习生和执业护士）总数从月度排班表中收集。采用相关性分析来研究住院时间与在急诊科轮转的实习医生数量之间的关系。进行独立样本t检验以比较急诊科有实习医生轮转和无实习医生轮转日子的平均住院时间差异。
平均每日住院时间为3.39至7.13小时（平均4.97小时，标准差[SD]0.59）。每天在急诊科轮转的实习医生数量为0至11人（平均5.32人，SD 2.39）。未发现住院时间与在急诊科轮转的实习医生数量之间存在显著关系（r = 0.06）。随后使用独立样本t检验的分析表明，即使急诊科没有实习医生轮转（平均4.93小时，SD 0.69）与至少有一名实习医生工作时（平均4.97小时，SD 0.59），住院时间也没有变化。
本研究结果表明，急诊科住院时间不受在急诊科轮转的实习医生（医学生、研究生一年级学生/实习生和执业护士）的存在或总数的影响。需要进一步研究以检查为容纳实习医生正在进行哪些调整（如果有的话），以及当实习医生与带教老师比例较高时教育质量是否会受到影响。
