title: Emergency medicine resident scheduling and patient exposure.
abstract: OBJECTIVE
  As a result of increasing emergency department census and patient waiting times at the authors' institution, attending physician staffing was increased, followed by a change in resident shift schedule. A study was undertaken to ascertain any change in residents' exposure to patients during the times before and immediately following the staffing and scheduling changes.
  
  
  METHODS
  The number and triage acuity of patients seen by residents were recorded and compared during four distinct time periods: two historical control periods with double attending coverage and two simultaneously scheduled residents; a period of triple attending coverage with two simultaneously scheduled residents; and a final period of triple attending coverage and staggered resident scheduling.
  
  
  RESULTS
  Residents tend to see more patients per shift as the academic year progresses (mean increase of two per shift between fall and spring [95% CI = 1.5 to 2.4]). The increase to triple attending coverage during peak times did not alter the number or acuity of patients being seen by emergency medicine residents. However, a change in the resident's schedule from simultaneous day shifts to staggered day and night shifts was associated with a crude decrease in the number of patients seen by 0.7 per shift (95% CI = 0 to 1.3), and a decrease of 1.0 (95% CI = 0.4 to 1.2) when adjusted for patient census.
  
  
  CONCLUSIONS
  After an increase in attending coverage, there was no change in the number or triage acuity of patients seen by residents. Staggered scheduling may decrease residents' exposure to patients compared with simultaneous scheduling.
authors.affiliation: Division of Emergency Medicine, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. jcush001@umaryland.edu
authors.forename: Jeremy T
authors.initials: JT
authors.lastname: Cushman
authors.forename: Michael D
authors.initials: MD
authors.lastname: Witting
mesh_terms: D002983:Clinical Competence; D016001:Confidence Intervals; D004635:Emergency Medicine / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D016014:Linear Models; D008297:Male; D008396:Maryland; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D011336:Probability; D012189:Retrospective Studies; D013997:Time Factors; D017749:Total Quality Management; D014218:Triage; D014505:Urban Population; D014940:Work Schedule Tolerance; D000078329:Workforce; D016526:Workload