Rosenow Christian, Aguirre Sophia, Polveroni Thomas, Ginsberg Zachary, Pollock Jordan, Traub Stephen, Rappaport Douglas
Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA.
Brown University, Providence, RI, USA.
Arch Acad Emerg Med. 2022 Apr 30;10(1):e33. doi: 10.22037/aaem.v10i1.1516. eCollection 2022.
The clinical diversity of patients presenting to the emergency department (ED) allows emergency medicine (EM) and non-EM residents to sharpen their clinical skills. In most EDs, residents self-assign patients at their discretion. Our institution transitioned from a self-assignment-system to an automated-system, after which we sought to determine the productivity of our non-EM residents compared to the previous system.
In this retrospective cross-sectional study, resident productivity was measured as number of patient visits per hour and per 8.5-hour shift before and after the implementation of an automated patient assignment system in emergency department. The automated-system assigns one patient at the start of the shift, another 30 minutes later, and one patient every hour thereafter, throughout the shift.
28 residents performed 406 total shifts prior to implementation and 14 residents performed 252 total shifts post-implementation. The average number of patient visits per hour significantly increased from 0.52 ± 0.18 (95% CI 0.45-0.59, IQR 0.43-0.60) to 0.82 ± 0.11 (95% CI 0.75-0.88, IQR 0.74-0.89) after implementation of our assignment system (p<0.00001; figure 1). Additionally, the average number of patient visits per 8.5-hour shift significantly increased from 4.46 ± 1.53 (CI 3.86-5.05, IQR 3.66-5.08) to 6.52 ± 0.86 (CI 6.02-7.02, IQR 5.90-7.09) after the implementation of our system (p<0.00001; figure 1).
These findings warrant further evaluation of the impact of patient assignment systems on trainee education.
前往急诊科（ED）就诊的患者临床情况多样，这使急诊医学（EM）住院医师和非急诊医学住院医师能够提高他们的临床技能。在大多数急诊科，住院医师自行决定接收患者。我们机构从自行分配系统转变为自动化系统，之后我们试图确定与之前系统相比，非急诊医学住院医师的工作效率。
在这项回顾性横断面研究中，在急诊科实施自动患者分配系统前后，以每小时和每8.5小时轮班的患者就诊次数衡量住院医师的工作效率。自动化系统在轮班开始时分配一名患者，30分钟后再分配一名，此后每小时分配一名患者，直至轮班结束。
实施前28名住院医师共进行了406次轮班，实施后14名住院医师共进行了252次轮班。实施我们的分配系统后，每小时的平均患者就诊次数从0.52±0.18（95%CI 0.45 - 0.59，IQR 0.43 - 0.60）显著增加至0.82±0.11（95%CI 0.75 - 0.88，IQR 0.74 - 0.89）（p<0.00001；图1）。此外，实施我们的系统后，每8.5小时轮班的平均患者就诊次数从4.46±1.53（CI 3.86 - 5.05，IQR 3.66 - 5.08）显著增加至6.52±0.86（CI 6.02 - 7.02，IQR 5.90 - 7.09）（p<0.00001；图1）。
这些发现值得进一步评估患者分配系统对实习生教育的影响。
