Impact of a Resident Strike on Emergency Department Quality Indicators at an Urban Teaching Hospital

Abstract

Abstract. Objective:To evaluate the indicators of activity and quality within the emergency department (ED) during a resident physicians' strike. Methods: This was an observational study comparing a strike period (SP) and a non-strike period (NSP) in the ED of a 1,000-bed tertiary care teaching hospital in Barcelona, Spain, with an annual census of 100,000 emergency visits. During a period of nine nonconsecutive days, the resident physicians were on strike. Emergency visits were handled by staff members. Data were compared between all patients treated in the ED during the SP and those treated during the NSP, matched by the weekday. The authors compared lengths of stay (LOSs), rates of use of laboratory tests and radiology procedures, numbers of patient walkouts, patient/physician ratios, emergency hospital admission rates, home discharge rates, unscheduled return rates, and mortality rates. Results:The two groups (SP 2,610 patients and NSP 3,634 patients) were comparable in terms of average daily attendance rate (SP: 290 Ϯ 12 vs NSP: 302 Ϯ 21; p = 0.13), elective hospital admission rate, and severity of illness. Statistically significant differences were found in terms of mean total patients' LOS (SP: 206.75 Ϯ 12.27 vs NSP: 235.10 Ϯ 27.08 minutes; p < 0.001), number of laboratory tests per patient (SP: 0.30 Ϯ 0.05 vs NSP: 0.38 Ϯ 0.04; p < 0.001), and radiographs per patient (SP: 0.78 Ϯ 0.06 vs NSP: 0.88 Ϯ 0.09; p = 0.021). Conclusions: This study demonstrated that replacing residents with staff physicians resulted in fewer laboratory tests ordered, fewer radiographs ordered, and shorter lengths of stays in the ED.

Impact of Family Medicine Resident Physicians on Emergency Department Wait Times and Patients Leaving Without Being Seen

“…Previous studies have shown either no difference or an increase in wait time with resident physicians working. [1][2][3][4] Our study used a single time period to analyze wait times, in order to mitigate the confounding factors of other changes within the ED over time. Occasional physicians work <10 shifts at the study hospital over one year.…”

“…4 Using a time period during a residents' strike in Spain, one study demonstrated that shifts where staff physicians worked by themselves resulted in significantly shorter LOS and fewer laboratory and radiographic tests ordered. 2 The reduced number of tests was likely a major factor responsible for the reduced LOS. In another study in a pediatric ED where residents are always present, patients seen by trainees were associated with a greater LOS of 17 minutes compared with patients seen only by the staff physician, but because residents were always present, the study could not determine residents' effects on mean wait times for the entire department.…”

“…Current literature from the United States and Europe would suggest that resident physicians either have no impact or increase ED wait times. [1][2][3][4] However, the majority of these studies used different time periods for analysis with a before-and-after design, where changes in hospital and health-care-system-based factors between time periods, could also impact wait times, in addition to confounders such as inefficiencies within a newly introduced (yet to be optimized) residency program. Given the discordance in the literature, we designed a robust method to analyze the effect of residents on ED wait times.…”

Impact de l’offre de stages sur la performance des établissements de santé et de services sociaux

“…Il ressort dans quatre études que la durée de diverses chirurgies est plus longue avec la participation des résidents ou des stagiaires [13,15,22,23] , alors que trois autres affirment que leur collaboration permet de diminuer le temps opératoire [17,24,25] . Certaines études ont également mis en évidence des durées d'intervention significativement plus longues en présence de résidents pour le temps de décision et la durée du séjour au service d'urgence avant d'admettre un patient [19] , ainsi que le temps global de traitement à l'urgence [26] .…”

Clinical Supervision in the Emergency Department: A Costly Inefficiency for Academic Medical Centers

“…However, the authors did find that length of stay, ancillary testing, and the number of patients leaving without being seen were all reduced when the ED was staffed by faculty. 2 How do the results of this study apply to the practice of emergency medicine (EM) in U.S. teaching hospitals? There are many differences between the practice of EM in U.S. teaching hospitals and those in Barcelona.…”