Jewell Corlin M, Bai Guangyu Anthony, Hekman Dann J, Nicholson Adam M, Lasarev Michael R, Alexandridis Roxana, Schnapp Benjamin H
University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin.
Indiana University School of Medicine-Northwest, Gary, Indiana.
West J Emerg Med. 2025 Mar;26(2):254-260. doi: 10.5811/westjem.20282.
Patients seen per hour (PPH) is a popular metric for emergency medicine (EM) resident efficiency, although it is likely insufficient for encapsulating overall efficiency. In this study we explored the relationship between higher patient complexity, acuity on shift, and markers of clinical efficiency.
We performed a retrospective analysis using electronic health record data of the patients seen by EM residents during their final year of training who graduated between 2017-2020 at a single, urban, academic hospital. We compared the number of PPH seen during the third (final) year to patient acuity (Emergency Severity Index), complexity (Current Procedural Terminology codes [CPT]), propensity for admissions, and generated relative value units (RVU).
A total of 46 residents were included in the analysis, representing 178,037 total cases. The number of PPH increased from first to second year of residency and fell slightly during the third year of residency. Overall, for each 50% increase in the odds of treating a patient requiring high-level evaluation and management (CPT code 99215), there was a 7.4% decrease in mean PPH. Each 50% increase in odds of treating a case requiring hospital admission was associated with a 6.7% reduction (95% confidence interval [CI] 0.73-12%; P = 0.03) in mean PPH. Each 0.1-point increase in PPH was associated with a 262 (95% CI 157-367; P < 0.001) unit increase in average RVUs generated.
Seeing a greater number of patients per hour was associated with a lower volume of complex patients and patients requiring admission among EM residents.
每小时接诊患者数（PPH）是衡量急诊医学（EM）住院医师效率的常用指标，尽管它可能不足以全面反映整体效率。在本研究中，我们探讨了患者复杂性增加、轮班时的急症程度与临床效率指标之间的关系。
我们使用一家城市学术医院2017年至2020年毕业的EM住院医师在培训最后一年接诊患者的电子健康记录数据进行回顾性分析。我们比较了第三年（最后一年）的PPH数量与患者急症程度（急诊严重程度指数）、复杂性（现行程序术语编码[CPT]）、入院倾向，并生成相对价值单位（RVU）。
共有46名住院医师纳入分析，代表178037例病例。PPH数量从住院医师第一年到第二年增加，在住院医师第三年略有下降。总体而言，治疗需要高级评估和管理的患者（CPT编码99215）的几率每增加50%，平均PPH下降7.4%。治疗需要住院的病例的几率每增加50%，平均PPH降低6.7%（95%置信区间[CI]0.73 - 12%；P = 0.03）。PPH每增加0.1分，平均生成的RVU增加262个单位（95% CI 157 - 367；P < 0.001）。
急诊医学住院医师每小时接诊更多患者与复杂患者和需要住院的患者数量减少有关。
