The effects of the absence of emergency medicine residents in an academic emergency department.
OBJECTIVE
What are the quality effects of an emergency medicine (EM) residency, and the associated 24/7 supervision of residents by faculty, in an academic emergency department (ED)? The authors evaluated activity and quality indicators when there were no EM residents present. The hypothesis of the study was that there was no difference between the patient care provided by faculty supervising EM residents and that with an alternative model without EM residents (AbsenceEMResident).


METHODS
To support the weekly residency educational program (Thursday), EM residents are not scheduled clinically for a 24-hour period (ConfDay). Emergency medicine resident coverage (mean 62.7 hours) was replaced with incremental faculty and mid-level providers (mean 41.0 hours). This study was limited to adult patients (22,527 visits of 39,190 ED total) for six months (January-June 2001) and compared indicators for ConfDay (n = 23) with all other days (NotConfDay, n = 158).


RESULTS
Comparing ConfDay (2,842 visits) with NotConfDay (19,685 visits), there was no difference in mean daily visits, inpatient admissions, intensive care unit admissions, or emergency medical services arrivals. ConfDay decision-to-admit time (333 vs. 313 min, p = 0.03) and length of stay for admissions (490 vs. 445 min, p = 0.000) were longer, with no difference for treat/release patients. There was no difference in the numbers of laboratory or radiology tests, consultations, unscheduled return visits, or patient satisfaction.


CONCLUSIONS
During the study period, there was no measurable difference for most of the quality indicators studied. The AbsenceEMResident model is less efficient in admitting patients. Faculty supervision results in the same number of laboratory and radiology tests and consultations. Other specialties may consider this model if off-hours care becomes a concern.
French
Daniel
D
Department of Emergency Medicine, University of Rochester, Strong Memorial Hospital, Rochester, NY 14642, USA.
Zwemer
Frank L
FL
Schneider
Sandra
S
D000328:Adult; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency; D009518:New York; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D000078329:Workforce