title: Impact of trainees on length of stay in the emergency department at an Academic Medical Center.
abstract: OBJECTIVE
  Emergency department (ED) overcrowding remains a growing concern despite continued efforts by hospitals to improve efficiency while also maintaining quality of care and medical education. The purpose of this study was to examine whether the total number of trainees rotating in the ED affects length of stay (LOS).
  
  
  METHODS
  This was a single-center study conducted at an urban university teaching hospital and level I trauma center that averages 65,000 adult ED visits per year. Data were collected retrospectively during a 13-month period from September 2012 to September 2013. The mean daily LOS was generated by the hospital's electronic medical record system, and the total number of trainees (medical students, postgraduate year-1 students/interns, and nurse practitioners) rotating in the ED each day was collected from monthly shift calendars. Correlations were used to examine the relation between LOS and number of trainees rotating in the ED. Independent sample t tests were conducted to compare differences in average LOS on days with and without trainees rotating in the ED.
  
  
  RESULTS
  The mean daily LOS ranged from 3.39 to 7.13 hours (mean 4.97, standard deviation [SD] 0.59). The number of trainees rotating in the ED each day ranged from 0 to 11 (mean 5.32, SD 2.39). No significant relation was found between LOS and the number of trainees rotating in the ED (r = 0.06). Subsequent analyses using independent sample t test revealed that LOS did not vary even when no trainees were rotating in the ED (mean 4.93, SD 0.69) versus when at least one trainee was working (mean 4.97, SD 0.59).
  
  
  CONCLUSIONS
  Findings from this study suggest that ED LOS is unaffected by the presence or total number of trainees (medical students, postgraduate year-1 students/interns, and nurse practitioners) rotating in the ED. Further research is needed to examine what, if any, adjustments are being made to accommodate trainees and whether the quality of education suffers when the trainee-to-attending ratio is high.
authors.affiliation: From the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: Erin
authors.initials: E
authors.lastname: Dehon
authors.affiliation: From the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: Gerald
authors.initials: G
authors.lastname: McLemore
authors.affiliation: From the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: L Kendall
authors.initials: LK
authors.lastname: McKenzie
mesh_terms: D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D009722:Nurse Practitioners / Q000193:education / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013337:Students, Medical / Q000706:statistics & numerical data; D013997:Time Factors; D000078329:Workforce