Patient Safety and Quality
Background: ED throughput has increasingly been used as a marker of institutional quality. We sought to determine the impact of throughput initiatives on resident productivity and satisfaction.
Methods: This retrospective cohort study was conducted in a tertiary care teaching hospital with a PGY1-3 EM residency program as a pre and post-implementation trial utilizing August 2017 vs August 2018 respectively. Over this period, comprehensive throughput initiatives were implemented. Hospital turnaround time (TAT) data was collected via tracking software to determine throughput time improvements.
The primary outcome was resident productivity as defined by patients per hour (PPH) and relative value units (RVUs) per hour as obtained via billing software.
Secondary outcome measures were resident satisfaction with these initiatives as measured using a visual analogue scale (VAS) survey to determine if there was a perceived impact on bedside teaching, wellness or patient care.
We used paired t-test to compare pre and post data.
Results: 31 2017 PGY1-3 residents’ productivity data and 33 2018 PGY1-3 residents’ data were compared. ED door to inpatient bed time was decreased from 518 (August 2017) to 263 (August 2018) minutes.
Residents’ average PPH was 1.12 (95%CI 0.96-1.29) in 2017 vs 1.16 (95%CI 1.00-1.31) in 2018. Resident RVUs per hour averaged 4.95 (95%CI 4.23-5.68) in 2017 vs 5.35 (95% CI 4.62-6.08) in 2018. Residents averaged 4.45 RVUs per patient (95%CI 4.32-4.59) in 2017 vs 4.61 RVUs per patient (95% CI 4.49-4.72) in 2018.
PGY3 resident PPH increased from 1.31 (95%CI 1.23-1.39) in 2017 to 1.59 PPH (95%CI 1.47-1.72) in 2018. PGY3 resident RVUs per hour increased from 6.11 (95% CI 5.78-6.43) in 2017 to 7.51 (95% CI 7.10-7.92) in 2018.
VAS satisfaction scores from 2017 to 2018 revealed no significant perceived impact on bedside teaching (4.6 cm, CI 4.12 to 5.00 vs 5.0 cm, CI 4.38 to 5.55), resident wellness (4.7 cm, CI 4.18 to 5.25 vs 5.2 cm, CI 4.59 to 5.74) or patient care (5.1 cm, CI 4.37 to 5.76 vs 6.0 cm, CI 5.26 to 6.67) as a result of the initiatives.
Conclusion: Despite a 255-minute reduction in ED TAT, there was no significant impact on overall resident productivity, however, there was increased productivity by PGY3 residents. The emphasis on throughput did not result in the perception of reduced bedside teaching, wellness or patient care.