title: Increasing off-service resident productivity while on their emergency department rotation using shift cards.
abstract: BACKGROUND
  Differences in productivity between off-service residents rotating in the emergency department (ED) and their emergency medicine (EM) resident counterparts have never been directly quantified.
  
  
  OBJECTIVE
  We sought to quantify the difference between off-service residents rotating in the ED and their EM resident counterparts. We also sought to find whether shift cards could be used to increase the productivity of off-service residents rotating in the ED.
  
  
  METHODS
  This is a prospective cohort study conducted at an urban, tertiary, Level I trauma center. We implemented the use of shift cards for off-service residents during their EM rotation. Completion of the shift card involved recording patients seen and their dispositions, procedures done, and documenting a learned bedside teaching point from their shift that day. Productivity was measured in terms of patients seen per hour (PPH) and relative value units per hour (RVU/h).
  
  
  RESULTS
  Off-service residents showed a productivity of 0.529 PPH (95% confidence interval [CI] 0.493-0.566) and 1.40 RVU/h (95% CI 1.28-1.53) prior to implementation of shift cards. With the introduction of shift cards, productivity increased to 0.623 PPH (95% CI 0.584-0.663, p = 0.001) and 1.77 RVU/h (95% CI 1.64-1.91, p = 0.001). In comparison, first year EM resident productivity was 0.970 PPH (95% CI 0.918-1.02) and 3.01 RVU/h (95% CI 2.83-3.19).
  
  
  CONCLUSIONS
  Shift cards can be used to foster motivation for off-service residents rotating in the ED, and is a simple and cost-effective method to improve system-based practices and utilization of resources.
authors.affiliation: Department of Emergency Medicine, Irvine School of Medicine, University of California, Orange, California.
authors.forename: Bharath
authors.initials: B
authors.lastname: Chakravarthy
authors.affiliation: Department of Emergency Medicine, Irvine School of Medicine, University of California, Orange, California.
authors.forename: Emerson
authors.initials: E
authors.lastname: Posadas
authors.affiliation: Department of Emergency Medicine, Irvine School of Medicine, University of California, Orange, California.
authors.forename: Deena
authors.initials: D
authors.lastname: Ibrahim
authors.affiliation: Department of Emergency Medicine, Irvine School of Medicine, University of California, Orange, California.
authors.forename: Kurt
authors.initials: K
authors.lastname: McArthur
authors.affiliation: Department of Emergency Medicine, Irvine School of Medicine, University of California, Orange, California.
authors.forename: Megan
authors.initials: M
authors.lastname: Osborn
authors.affiliation: Department of Emergency Medicine, Irvine School of Medicine, University of California, Orange, California.
authors.forename: Wirachin
authors.initials: W
authors.lastname: Hoonpongsimanont
authors.affiliation: Department of Emergency Medicine, Irvine School of Medicine, University of California, Orange, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wong
authors.affiliation: Department of Emergency Medicine, Irvine School of Medicine, University of California, Orange, California.
authors.forename: Shahram
authors.initials: S
authors.lastname: Lotfipour
mesh_terms: D000328:Adult; D003625:Data Collection / Q000379:methods*; D017598:Efficiency, Organizational; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011446:Prospective Studies
keywords: education; emergency medicine; off-service; productivity; resident