Do Slow and Steady Residents Win the Race? Modeling the Effects of Peak and Overall Resident Productivity in the Emergency Department

The Effect of Signed-Out Emergency Department Patients on Resident Productivity

“…The stark increase in the cost associated with additional sign-out patients from the PGY-1 to PGY-2 year ran counter to our initial expectations. Most prior studies of resident productivity, whether examining the total number of patients seen or the number of RVUs generated, have demonstrated a consistent improvement across years of training, and most prominently between these first 2 years (12)(13)(14)(15)(16). As residents become more efficient at seeing patients, we expected that they would become more facile at handling additional patients received in sign-out, which would be reflected by a smaller decrease in productivity associated with each additional signed-out patient.…”

“…Due to the fact that caring for signed-out patients increases the amount of work a resident must do, and increases the potential for interruptions, we hypothesized that managing a larger number of signed-out patients would be associated with decreased overall productivity. Because previous studies of resident productivity have shown a strong, positive association between training and productivity, we anticipated that any detrimental effects from signout on productivity would be decreased in successive years of training (12)(13)(14)(15)(16). As a secondary analysis, we sought to determine whether different kinds of signed-out patients (such as patients in an ED observation unit) were associated with differing effects on productivity.…”

Experience Within the Emergency Department and Improved Productivity for First-Year Residents in Emergency Medicine and Other Specialties

“…The development of EM resident productivity over the course of training has been examined by a number of studies, which have consistently found that the greatest increases in productivity occur during intern year, regardless of the measure used to evaluate productivity (such as patients per hour or RVUs). 2 – 7 , 15 When viewed in terms of patients per hour (the most common resident productivity metric in the literature) our findings of 0.90 (95% CI [0.86 – 0.93]) patients per hour at the beginning of the year are similar to those seen for EM interns in prior studies, which have ranged from as low as 0.73 (95% CI [0.62 – 0.94]) 3 to as high as 1.11 (95% CI [1.02 – 1.20]). 16 …”

Understanding Demand and Capacity Mismatch in an Academic Emergency Department Using a Staircase Model of Provider Capacity and Staggered Shift Start Times

“…If multiple patients arrive at 6 am , the residents will still often see at least some of them even though we have assumed no patient capacity during that hour. Similarly, if there are extreme circumstances, such as a spike in arrivals for a given hour or multiple critical patients at the same time, residents can stretch their capacity temporarily to meet this demand ( 11 ). These fluctuations in resident effort are difficult to account for in the model, which is based on historic average capacity.…”