Comparison of resident and mid-level provider productivity and patient satisfaction in an emergency department fast track

Jeanmonod, Rebecca; Delcollo, Jessica; Jeanmonod, Donald; Dombchewsky, Orest; Reiter, Mark

doi:10.1136/emermed-2011-200572

Cited by 25 publications

(24 citation statements)

References 26 publications

(13 reference statements)

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“…8,10,11 Although the clinical value of residents compared to midlevel providers remains unknown in neurology, comparisons in emergency medicine and primary care suggest similar clinical value. [26][27][28] Our study explores some of the ways that departments and programs employ their new and existing faculty to assist with the loss of resident work, finding that faculties are frequently assisting residents in leading family meetings. This may have unintended consequences on the value of resident education.…”

Section: Discussionmentioning

confidence: 99%

Impact of 2011 Resident Duty Hour Requirements on Neurology Residency Programs and Departments

George

Probasco

Dorsey

et al. 2014

The Neurohospitalist

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Objective: In 2011, the Accreditation Council on Graduate Medical Education (ACGME) redefined resident duty hour requirements by reducing in-hospital duty hour requirements for residents in an effort to improve patient care, resident wellbeing, and resident education. We sought to determine the cost of adoption based on changes made by neurology residency programs and departments due to these requirements. Methods: We surveyed department chairs or residency program directors at 123 ACGME-accredited US adult neurology training programs on programmatic changes and resident expansion, hiring practices, and development of new computer-based resources in direct response to the 2011 ACGME duty hour requirements. Using data from publicly available resources, we estimated respondents' financial cost of adoption. Results: In all, 63 responded (51% response rate); 76% were program directors. The most common changes implemented by programs were adding night float systems (n ¼ 31; 49%) and increasing faculty responsibility (n ¼ 26; 41%). In direct response to the requirements, 21 programs applied to ACGME for 40 additional residents, 29 of which were fully covered by institutional funds. In direct response to the requirements, nearly half of the departments (n ¼ 26) hired individuals for a total of 80 hires (or 64 full-time equivalents), most commonly mid-level practitioners. The total estimated cost to responding departments was US $12.7 million or US $201,000 per department annually. When projecting expenses of planned changes for the following year, costs increased to US $360,000 per department, with 5-year costs exceeding US $1 million. Conclusions: The most recent restriction on resident duty hours comes at substantial cost to neurology departments and residency programs.

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Section: Discussionmentioning

confidence: 99%

Impact of 2011 Resident Duty Hour Requirements on Neurology Residency Programs and Departments

George

Probasco

Dorsey

et al. 2014

The Neurohospitalist

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“…This calculation used prior data on the same MLPs’ productivity extrapolated from low-acuity shifts at another site 8. Data were analysed using the two-tailed t test to compare pt/h, RVU/h, RVU/pt and daily census between the two groups.…”

Section: Methodsmentioning

confidence: 99%

Comparison of resident and mid-level provider productivity in a high-acuity emergency department setting

et al. 2013

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“…Although the research on innovative staffing models is still evolving, the existing evidence indicates that utilizing nurse practitioners or physician assistants as part of the overall ED health care team can have positive effects on both patient flow 82,83 and patient satisfaction. [84][85][86] Although a certain percentage of pediatric patients are acutely ill or injured, many patients are of lower acuity and arrive during predictable peak periods, most notably during evening and weekend hours. The use of nurse practitioners and physician assistants in lower-acuity settings during peak hours, for example, has been found to be particularly effective at alleviating the stress that highervolume, lower-acuity patients have on the system.…”

Section: Innovative Staffing Modelsmentioning

confidence: 99%

“…Wait times are known to be a key factor in patient satisfaction, and studies have shown that patient satisfaction scores are often lowest among the lower-acuity patients. 84 The low-acuity environment has, therefore, become a focus for innovative care solutions that can reduce wait times for all patients, not just those with minor presentations. 98 A systematic search of the English and French literature included 66 papers on the use of physician assistants in EDs and studied several outcomes, including changes in patient flow and patient satisfaction, during the period of physician assistant utilization.…”

Section: Innovative Staffing Modelsmentioning

confidence: 99%

Best Practices for Improving Flow and Care of Pediatric Patients in the Emergency Department

Barata¹,

Brown²,

Fitzmaurice³

et al. 2015

Pediatrics

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This report provides a summary of best practices for improving flow, reducing waiting times, and improving the quality of care of pediatric patients in the emergency department. CURRENT STATUS AND NEEDS ED Use and ED Crowding in the United StatesApproximately 800 000 children seek care in the emergency department (ED) each day in the United States. Additionally, it is estimated that 3.4% of US children use EDs as their source for sick care. The vast majority (92%) of these children are seen in community EDs, with a smaller percentage seen in pediatric EDs. The increase in ED utilization has saturated the capacity of EDs and emergency medical services in many communities. Increases in patient volume and decreases in resources, including fragmentation of resources and shortage of critical subspecialists, have resulted in EDs facing crowding and ambulance diversion.The need for emergency medical services outstrips the available resources on a daily basis. This mismatch is reflected by the considerable increase in the number of patients visiting EDs. In 1993, 90.3 million patients visited EDs; in 2003 that number increased to 113.9 million patients. Approximately 21% of these patients were younger than 15 years. Despite the increase in ED visits, the number of hospitals decreased by 703, the number of hospital beds decreased by 198 000, and the number of EDs decreased by 425.

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Comparison of resident and mid-level provider productivity and patient satisfaction in an emergency department fast track

Abstract: In a low acuity area of the ED, MLPs treated more patients per hour and generated more RVUs per hour than EM resident physicians. However, resident physicians generated more RVUs per patient. Patient satisfaction did not differ.

Cited by 25 publications

References 26 publications

Impact of 2011 Resident Duty Hour Requirements on Neurology Residency Programs and Departments

Impact of 2011 Resident Duty Hour Requirements on Neurology Residency Programs and Departments

Comparison of resident and mid-level provider productivity in a high-acuity emergency department setting

Best Practices for Improving Flow and Care of Pediatric Patients in the Emergency Department

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