Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, United States of America.
University of North Texas Health Science Center, Fort Worth, TX, United States of America.
PLoS One. 2020 Feb 5;15(2):e0228719. doi: 10.1371/journal.pone.0228719. eCollection 2020.
Attending physician productivity and efficiency can be affected when working simultaneously with Residents. To gain a better understanding of this effect, we aim to compare productivity, efficiency, and overall performance differences among Attendings working solo versus working with Residents in an Emergency Department (ED).
Data were extracted from the electronic medical records of all patients seen by ED Attendings and/or Residents during the period July 1, 2014 through June 30, 2017. Attending productivity was measured based on the number of new patients enrolled per hour per provider. Attending efficiency was measured based on the provider-to-disposition time (PDT). Attending overall performance was measured by Attending Performance Index (API). Furthermore, Attending productivity, efficiency, and overall performance metrics were compared between Attendings working solo and Attendings working with Residents. The comparisons were analyzed after adjusting for confounders via propensity score matching.
A total of 15 Attendings and 266 Residents managing 111,145 patient encounters over the study period were analyzed. The mean (standard deviation) of Attending productivity and efficiency were 2.9 (1.6) new patients per hour and 2.7 (1.8) hours per patient for Attendings working solo, in comparison to 3.3 (1.9) and 3.0 (2.0) for Attendings working with Residents. When paired with Residents, the API decreased for those Attendings who had a higher API when working solo (average API dropped from 0.21 to 0.19), whereas API increased for those who had a lower API when working solo (average API increased from 0.13 to 0.16).
In comparison to the Attending working solo staffing model, increased productivity with decreased efficiency occurred among Attendings when working with Residents. The overall performance of Attendings when working with Residents varied inversely against their performance when working solo.
当主治医生与住院医生同时工作时，可能会影响其工作效率和生产力。为了更好地了解这种影响，我们旨在比较主治医生在急诊科（ED）单独工作与与住院医生一起工作时的生产力、效率和整体绩效差异。
从 2014 年 7 月 1 日至 2017 年 6 月 30 日期间所有由 ED 主治医生和/或住院医生诊治的患者的电子病历中提取数据。主治医生的生产力根据每位医生每小时新收治的患者数量来衡量。主治医生的效率根据医生到处置的时间（PDT）来衡量。主治医生的整体绩效通过主治医生绩效指数（API）来衡量。此外，还比较了单独工作的主治医生和与住院医生一起工作的主治医生的生产力、效率和整体绩效指标。通过倾向评分匹配调整混杂因素后对这些比较进行了分析。
在研究期间，共有 15 名主治医生和 266 名住院医生管理了 111145 例患者。单独工作的主治医生的生产力和效率平均值（标准差）分别为每小时 2.9（1.6）例新患者和每位患者 2.7（1.8）小时，而与住院医生一起工作的主治医生的平均值分别为 3.3（1.9）和 3.0（2.0）。与住院医生一起工作时，当主治医生的 API 高于单独工作时，其 API 降低（平均 API 从 0.21 降至 0.19），而当主治医生的 API 低于单独工作时，其 API 增加（平均 API 从 0.13 增至 0.16）。
与单独工作的主治医生配置模型相比，当主治医生与住院医生一起工作时，生产力提高但效率降低。主治医生与住院医生一起工作时的整体绩效与其单独工作时的绩效呈负相关。
