title: Modeling Hourly Resident Productivity in the Emergency Department.
abstract: OBJECTIVE
  Resident productivity, defined as new patients per hour, carries important implications for emergency department operations. In high-volume academic centers, essential staffing decisions can be made on the assumption that residents see patients at a static rate. However, it is unclear whether this model mirrors reality; previous studies have not rigorously examined whether productivity changes over time. We examine residents' productivity across shifts to determine whether it remained consistent.
  
  
  METHODS
  This was a retrospective cohort study conducted in an urban academic hospital with a 3-year emergency medicine training program in which residents acquire patients ad libitum throughout their shift. Time stamps of all patient encounters were automatically logged. A linear mixed model was constructed to predict productivity per shift hour.
  
  
  RESULTS
  A total of 14,364 8- and 9-hour shifts were worked by 75 residents between July 1, 2010, and June 20, 2015. This comprised 6,127 (42.7%) postgraduate year (PGY) 1 shifts, 7,236 (50.4%) PGY-2 shifts, and 998 (6.9%) PGY-3 nonsupervisory shifts (Table 1). Overall, residents treated a mean of 10.1 patients per shift (SD 3.2), with most patients at Emergency Severity Index level 3 or more acute (93.8%). In the initial hour, residents treated a mean of 2.14 patients (SD 1.2), and every subsequent hour was associated with a significant decrease, with the largest in the second, third, and final hours.
  
  
  CONCLUSIONS
  Emergency medicine resident productivity during a single shift follows a reliable pattern that decreases significantly hourly, a pattern preserved across PGY years and types of shifts. This suggests that resident productivity is a dynamic process, which should be considered in staffing decisions and studied further.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA. Electronic address: jwjoseph@bidmc.harvard.edu.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Joseph
authors.affiliation: Division of Emergency Medicine, University of Washington Medical School, Seattle, WA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Henning
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA.
authors.forename: Connie S
authors.initials: CS
authors.lastname: Strouse
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA.
authors.forename: David T
authors.initials: DT
authors.lastname: Chiu
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Nathanson
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA.
authors.forename: Leon D
authors.initials: LD
authors.lastname: Sanchez
mesh_terms: D004526:Efficiency; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D010561:Personnel Staffing and Scheduling; D010820:Physicians; D012189:Retrospective Studies; D014481:United States; D014940:Work Schedule Tolerance; D016526:Workload