title: Emergency department resource use by supervised residents vs attending physicians alone.
abstract: OBJECTIVE
  Few studies have evaluated the common assumption that graduate medical education is associated with increased resource use.
  
  
  OBJECTIVE
  To compare resources used in supervised vs attending-only visits in a nationally representative sample of patient visits to US emergency departments (EDs).
  
  
  METHODS
  Cross-sectional study of the National Hospital Ambulatory Medical Care Survey (2010), a probability sample of US EDs and ED visits.
  
  
  METHODS
  Supervised visits, defined as visits involving both resident and attending physicians. Three ED teaching types were defined by the proportion of sampled visits that were supervised visits: nonteaching ED, minor teaching ED (half or fewer supervised visits), and major teaching ED (more than half supervised visits).
  
  
  METHODS
  Association of supervised visits with hospital admission, advanced imaging (computed tomography, ultrasound, or magnetic resonance imaging), any blood test, and ED length of stay, adjusted for visit acuity, demographic characteristics, payer type, and geographic region.
  
  
  RESULTS
  Of 29,182 ED visits to the 336 nonpediatric EDs in the sample, 3374 visits were supervised visits. Compared with the 25,808 attending-only visits, supervised visits were significantly associated with more frequent hospital admission (21% vs 14%; adjusted odds ratio [aOR], 1.42; 95% CI, 1.09-1.85), advanced imaging (28% vs 21%; aOR, 1.27; 95% CI, 1.06-1.51), and a longer median ED stay (226 vs 153 minutes; adjusted geometric mean ratio, 1.32; 95% CI, 1.19-1.45), but not with blood testing (53% vs 45%; aOR, 1.18; 95% CI, 0.96-1.46). Of visits to the sample of 121 minor teaching EDs, a weighted estimate of 9% were supervised visits, compared with 82% of visits to the 34 major teaching EDs. Supervised visits in major teaching EDs compared with attending-only visits were not associated with hospital admission (aOR, 1.15; 95% CI, 0.83-1.58), advanced imaging (aOR, 1.21; 95% CI, 0.96-1.53), or any blood test (aOR, 1.02; 95% CI, 0.79-1.33), but had longer ED stays (adjusted geometric mean ratio, 1.32; 95% CI, 1.14-1.53).
  
  
  CONCLUSIONS
  In a sample of US EDs, supervised visits were associated with a greater likelihood of hospital admission and use of advanced imaging and with longer ED stays. Whether these associations are different in EDs in which more than half of visits are seen by residents requires further investigation.
authors.affiliation: Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Pitts
authors.affiliation: Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia2Emergency Department, St Vincent Infirmary Medical Center, Little Rock, Arkansas.
authors.forename: Sofie R
authors.initials: SR
authors.lastname: Morgan
authors.affiliation: Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Schrager
authors.affiliation: Emergency Medicine, University of Texas Southwestern Medical School, Austin.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult