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01-10-2019 | Triage | Original Scientific Report

Surgical Residents’ Proficiency and Turnover May Affect the Overall Efficiency in an Emergency Department

Authors: Francesco Mongelli, Henning Fischer, Michael Stickel, Miriam Patella, Nickolaus Heeren, Michael Christ, Markus Gass

Published in: World Journal of Surgery | Issue 10/2019

Abstract

Background

Within Emergency Department (ED), problem responsiveness and organizational capacity are extremely important for providing acute care. The “July effect” has been described as the period when junior doctors start new turnovers, possibly reflecting on hospital and ED efficiency. The objective of this study was to investigate the impact of residents’ turnover on ED efficiency at a Swiss teaching hospital.

Methods

We retrospectively evaluated patients presenting with surgical needs to ED from June 2014 to January 2019. Data regarding gender, age, length of stay (LOS), resident doctors and level of urgency were collected and analyzed.

Results

We identified 27,767 surgical admissions treated by 92 residents. The LOS analysis within residents’ period in the ED showed a progressive reduction over time, with 80% of proficiency achieved after 98 patients. The mean LOS was 257.3 and 237.6 min during and after the learning curve (p < 0.0001), although no difference was noted in triage level 1 patients (p = 0.813). By replacing 40–70% of residents (January and July), the LOS raised from 243.1 to 259.7 min (absolute difference 16.6 min, p < 0.001), but if only 10–20% of residents newly started, no difference was detected (p = 0.071).

Conclusions

Our study demonstrates that surgical residents’ turnover within the ED could affect the overall efficiency. The training period for new resident physicians was a caseload of 98 patients, respectively, 3 weeks of work. The impact of trainees’ turnover was only relevant if more than 40% of the resident team is replaced at one time and only less urgent cases were affected.

Bahl A, Hixson CC (2019) July phenomenon impacts efficiency of emergency care. West J Emerg Med 20(1):157–162CrossRef

Zugar A (2019) Essay: “It’s July, the greenest month in hospitals. No need to panic.” New York Times. Science Desk. 2018. Available at: https://www.nytimes.com/1998/07/07/science/essay-it-s-july-the-greenestmonth-in-hospitals-no-need-to-panic.html. Accessed Feb 16 2019

Phillips DP, Barker GE (2010) A July spike in fatal medication errors: a possible effect of new medical residents. J Gen Intern Med 25(8):774–779CrossRef

Myers L, Mikhael B, Currier P et al (2017) The association between physician turnover (the “July Effect”) and survival after in-hospital cardiac arrest. Resuscitation 114:133–140CrossRef

Kang H, Bastian ND, Riordan JP (2017) Evaluating the relationship between productivity and quality in emergency departments. J Healthc Eng 2–17:1–8CrossRef

Yaghoubian A, de Virgilio C, Chiu V et al (2010) “July effect” and appendicitis. J Surg Educ 67(3):157–160CrossRef

Ford AA, Bateman BT, Simpson LL et al (2007) Nationwide data confirms absence of ‘July phenomenon’ in obstetrics: It’s safe to deliver in July. J Perinatol 27(2):73–76CrossRef

Tanabe P, Travers D, Gilboy N et al (2005) Refining emergency severity index triage criteria. Acad Emerg Med 12(6):497–501CrossRef

Inaba K, Recinos G, Teixeira PG et al (2010) Complications and death at the start of the new academic year: is there a July phenomenon? J Trauma 68(1):19–22CrossRef

10.

Haller G, Myles PS, Taffé P et al (2009) Rate of undesirable events at beginning of academic year: retrospective cohort study. BMJ 339:b3974CrossRef

11.

Dhaliwal AS, Chu D, Deswal A et al (2008) The July effect and cardiac surgery: the effect of the beginning of the academic cycle on outcomes. Am J Surg 196(5):720–725CrossRef

12.

Tobert DG, Menendez ME, Ring DC et al (2018) The “July Effect” on shoulder arthroplasty: are complication rates higher at the beginning of the academic year? Arch Bone Jt Surg 6(4):277–281PubMedPubMedCentral

13.

Buchwald D, Komaroff AL, Cook EF et al (1989) Indirect costs for medical education: Is there a July phenomenon? Arch Intern Med 149(4):765–768CrossRef

14.

Barry WA, Rosenthal GE (2003) Is there a July phenomenon? The effect of July admission on intensive care mortality and length of stay in teaching hospitals. J Gen Intern Med 18(8):639–645CrossRef

15.

Bakaeen FG, Huh J, LeMaire SA et al (2009) The July effect: impact of the beginning of the academic cycle on cardiac surgical outcomes in a cohort of 70,616 patients. Ann Thorac Surg 88(1):70–75CrossRef

16.

Chousterman BG, Pirracchio R, Guidet B (2016) Impact of resident rotations on critically ill patient outcomes: results of a French multicenter observational study. PLoS ONE 11(9):e0162552CrossRef

17.

Riguzzi C, Hern HG, Vahidnia F et al (2014) The July effect: is emergency department length of stay greater at the beginning of the hospital academic year? West J Emerg Med 15(1):88–93CrossRef

18.

Rathlev NK, Chessare J, Olshaker J et al (2007) Time series analysis of variables associated with daily mean emergency department length of stay. Ann Emerg Med 49(3):265–271CrossRef

Title: Surgical Residents’ Proficiency and Turnover May Affect the Overall Efficiency in an Emergency Department
Authors: Francesco Mongelli
Henning Fischer
Michael Stickel
Miriam Patella
Nickolaus Heeren
Michael Christ
Markus Gass
Publication date: 01-10-2019
Publisher: Springer International Publishing
Keyword: Triage
Published in: World Journal of Surgery / Issue 10/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-05062-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical Residents’ Proficiency and Turnover May Affect the Overall Efficiency in an Emergency Department

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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