Dedicated Shift Wrap-up Time Does Not Improve Resident Sign-out Volume or Efficiency.
OBJECTIVE
Sign-out (SO) is a challenge to the emergency physician. Some training programs have instituted overlapping 9-hour shifts. The residents see patients for eight hours, and have one hour of wrap-up time. This hour helps them complete patient care, leaving fewer patients to sign-out. We examined whether this strategy impacts SO burden.


METHODS
This is a retrospective review of patients evaluated by emergency medicine (EM) residents working 9-hour (eight hours of patient care, one hour wrap-up time) and 12-hour shifts (12 hours patient care, no reserved time for wrap-up). Data were collected by reviewing the clinical tracker. A patient was assigned to the resident who initiated care and dictated the chart. SO was defined as any patient in the ED without disposition at change of shift. Patient turn-around-time (TAT) was also recorded.


RESULTS
One-hundred sixty-one postgraduate-year-one resident (PGY1), 264 postgraduate-year-two resident (PGY2), and 193 postgraduate-year-three resident (PGY3) shifts were included. PGY1s signed out 1.9 patients per 12-hour shift. PGY2s signed out 2.3 patients on 12-hour shifts and 1.8 patients on 9-hour shifts. PGY3s signed out 2.1 patients on 12-hour shifts and 2.0 patients on 9-hour shifts. When we controlled for patients seen per hour, SO burden was constant by class regardless of shift length, with PGY2s signing out 18% of patients seen compared to 15% for PGY3s. PGY1s signed out 18% of patients seen. TAT for patients seen by PGY1s and PGY2s was similar, at 189 and 187 minutes, respectively. TAT for patients seen by PGY3s was significantly less at 175 minutes.


CONCLUSIONS
The additional hour devoted to wrapping up patients in the ED had no affect on SO burden. The SO burden represented a fixed percentage of the total number of patients seen by the residents. PGY3s sign-out a smaller percentage of patients seen compared to other classes, and have faster TATs.
Jeanmonod
Rebecca K
RK
St. Luke's Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA.
Brook
Christopher
C
Winther
Mark
M
Pathak
Soma
S
Boyd
Molly
M
Qual Saf Health Care. 2005 Dec;14(6):401-7
16326783
Ann Surg. 2007 Feb;245(2):159-69
17245166
Jt Comm J Qual Patient Saf. 2008 Oct;34(10):563-70
18947116
Emerg Med Australas. 2007 Oct;19(5):433-41
17919216
Paediatr Anaesth. 2007 May;17(5):470-8
17474955
Jt Comm J Qual Patient Saf. 2006 Nov;32(11):646-55
17120925
Acad Emerg Med. 2007 Sep;14(9):790-4
17726123
JAMA. 2007 Feb 28;297(8):831-41
17327525
Ann Emerg Med. 1995 Mar;25(3):321-4
7864469
Ann Intern Med. 1994 Dec 1;121(11):866-72
7978700
BMC Health Serv Res. 2008 Dec 16;8:256
19087251
Acad Emerg Med. 2000 Jan;7(1):90-2
10894249
Ann Intern Med. 2005 Mar 1;142(5):352-8
15738454
J Adv Nurs. 1999 Jan;29(1):18-27
10064278
J Hosp Med. 2006 Jul;1(4):257-66
17219508
Ann Intern Med. 2006 Oct 17;145(8):592-8
17043341
J Am Osteopath Assoc. 2003 Jun;103(6):291-6
12834102
Surgery. 2004 Jul;136(1):5-13
15232532
Ann Emerg Med. 2009 Jun;53(6):701-10.e4
18555560
Int J Med Inform. 2007 Nov-Dec;76(11-12):801-11
17059892
Acad Emerg Med. 2005 Dec;12(12):1240-4
16293898
Acad Emerg Med. 2007 Feb;14(2):192-6
17192443
Ann Emerg Med. 1992 Oct;21(10):1250-8
1416310
Int J Qual Health Care. 2004 Apr;16(2):125-32
15051706
Am J Emerg Med. 2009 Mar;27(3):313-9
19328376
Ann Emerg Med. 1994 May;23(5):1096-100
8185106
Arch Intern Med. 2006 Jun 12;166(11):1173-7
16772243