Resident Productivity in the Emergency Department After Implementation of an Automated Patient Assignment System; a Brief Report

The clinical diversity of patients presenting to the emergency department (ED) allows emergencymedicine (EM) and non-EM residents to sharpen their clinical skills. In most EDs, residents self-assign pa-tients at their discretion. Our institution transitioned from a self-assignment-system to an automated-system,after which we sought to determine the productivity of our non-EM residents compared to the previous system.

In this retrospective cross-sectional study, resident productivity was measured as number of patientvisits per hour and per 8.5-hour shift before and after the implementation of an automated patient assignmentsystem in emergency department. The automated-system assigns one patient at the start of the shift, another30 minutes later, and one patient every hour thereafter, throughout the shift.

28 residents performed406 total shifts prior to implementation and 14 residents performed 252 total shifts post-implementation. Theaverage number of patient visits per hour significantly increased from 0.52 ± 0.18 (95% CI 0.45-0.59, IQR 0.43-0.60) to 0.82 ± 0.11 (95% CI 0.75-0.88, IQR 0.74-0.89) after implementation of our assignment system (p<0.00001;figure 1). Additionally, the average number of patient visits per 8.5-hour shift significantly increased from 4.46± 1.53 (CI 3.86-5.05, IQR 3.66-5.08) to 6.52 ± 0.86 (CI 6.02-7.02, IQR 5.90-7.09) after the implementation of oursystem (p<0.00001; figure 1).

These findings warrant further evaluation of the impact of patientassignment systems on trainee education.