EMERGENCY DEPARTMENT DISPOSITION: DO SURGICAL RESIDENTS CONTRIBUTE TO INEFFICIENCY?
CS Zhang, L Wang, J Saxe
St. Vincent Hospital
In the clinical learning environment, it is often challenging to provide timely patient care. Residents, especially surgery residents, are often viewed as one of the contributors to the prolongation of disposition time, particularly in the Emergency Department (ED). The purpose of this study is to establish the events in ED patient care and determine the contribution of surgical resident inefficiency to total disposition time.
A retrospective review of prospectively gathered data of 145 ED patients seen by the general surgery service between August 2019 to November 2020 was performed. Data included resident involvement by Post-Graduate Year, patient identifier, page time, and time of plan provided to the ED physician. Additionally, times for patient arrival, placement of imaging order, imaging completion, reading of imaging, and disposition were extracted from the patientís chart. A time analysis was performed.
The average time from patient arrival to disposition by the ED physician was 305 min (5 hr 5 min), of which, the resident spent on average 49 min (16%) from the time of page to review, examine, and staff the patient. The largest portions of time were arrival to imaging and imaging time, which were 75 min (25%) and 73 min (24%) of the total time, respectively. The average time for reading images was relatively short, 16 min (5%), and 49 min (16%) would elapse after the read before the resident was paged. Another 42 min (14%) after resident communication of the surgical plan would pass before the ED physicianís final disposition.
This study would indicate the general surgery residents respond and examine patients in a timely manner. Currently, our institution expectation for consulting services is 60 min for patient engagement. Surgery resident evaluation and disposition was consistently earlier than the hospital metric. Imaging time appears to be a significant bottleneck preventing more efficient patient evaluation and disposition.
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