Resident efficiency in a pediatric emergency department

Abstract

Objectives: To measure the hourly rate of patients evaluated and treated by resident physicians in an academic pediatric emergency department (PED) and examine differences in the rate by subspecialty and year of training.

Methods: For all residents rotating in an academic, urban children's hospital PED, the rate of patients seen per hour over the course of their rotation was calculated using an electronic tracking system, EmSTAT, for calendar year 2000. Rates are reported as the mean number of patients seen per resident hour worked. Mean differences are reported for resident subspecialties (emergency medicine, pediatrics, and family practice) and postgraduate year (PGY1-PGY3), and subclass comparisons were made with an analysis of variance test with Tukey's post hoc analysis.

Results: A total of 153 residents (63.4% pediatric, 18.9% family practice, and 17.7% emergency medicine) saw 24,414 patients during the study period. The makeup of the group by training year was as follows: PGY1, 20.9%; PGY2, 41.2%; and PGY3, 37.9%. For all residents, the mean rate was 1.02 patients seen per hour (pph). Significant differences in the mean number of patients seen per hour by subspecialty existed, with emergency medicine residents seeing a mean of 1.12 pph, pediatrics residents seeing 1.02 pph, and family practice residents seeing 0.93 pph (mean difference, p < 0.05 for all comparisons). Rates increased by year of training, with PGY1 seeing a mean of 0.95 pph, PGY2 seeing 0.99 pph, and PGY3 seeing 1.09 pph (mean difference, p < 0.05 for all comparisons except PGY1 vs. PGY2).

Conclusions: Significant differences in the rate of patients evaluated and treated in the PED exist by resident subspecialty and year of training. Knowing these rates is helpful in evaluation of resident performance, because it allows comparison with peers. Additionally, such information may be useful for residency program evaluators to gauge the amount of patient exposure for residents.