Background: Application for EM residency is becoming more competitive. Knowledge about geographic trends in matched residents may help programs streamline their recruitment process. Studies in other specialties have shown a high correlation between residency and medical school location.Objective: This study seeks to determine whether a correlation exists between the geographic location that an emergency medicine resident matched and their medical school location.Methods: We identified allopathic emergency medicine residencies via The AMA FREIDA Residency Database. We used public websites created by residency programs to obtain individual demographic information.Results: There are 164 Allopathic EM programs in the
Purpose
Emergency department (ED) crowding is increasing and is associated with adverse patient outcomes. The objective of this study was to measure the relative impact of ED boarding on timeliness of early ED care for new patient arrivals, with a focus on the differential impact in low‐volume rural hospitals.
Methods
A retrospective cohort of all patients presenting to a Veterans Health Administration (VHA) ED between 2011 and 2014. The primary exposure was the number of patients in the ED at the time of ED registration, stratified by disposition (admit, discharge, or transfer) and mental health diagnosis. The primary outcome was time‐to‐provider evaluation, and secondary outcomes included time‐to‐EKG, time‐to‐laboratory testing, time‐to‐radiography, and total ED length‐of‐stay. Rurality was measured using the Rural‐Urban Commuting Areas.
Findings
A total of 5,912,368 patients were included from all 123 VHA EDs. Adjusting for acuity, new patients had longer time‐to‐provider when more patients were in the ED, and patients awaiting transfer for nonmental health conditions impacted time‐to‐provider for new patients (16.6 min delays, 95% CI: 12.3–20.7 min) more than other patient types. Rural patients saw a greater impact of crowding on care timeliness than nonrural patients (additional 5.3 min in time‐to‐provider per additional patient in ED, 95% CI: 4.3–6.4), and the impact of additional patients in all categories was most pronounced in the lowest‐volume EDs.
Conclusions
Patients seen in EDs with more crowding have small, but additive, delays in early elements of ED care, and transferring patients with nonmental health diagnoses from rural facilities were associated with the greatest impact.
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