Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity
Introduction: Patients seen per hour (PPH) is a popular metric for emergency medicine (EM) resident efficiency, although it is likely insufficient for encapsulating overall efficiency. In this study we explored the relationship between higher patient complexity, acuity on shift, and markers of clini...
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| Format: | Article |
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eScholarship Publishing, University of California
2025-01-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/5wg3g98h |
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| author | Corlin M. Jewell Guangyu (Anthony) Bai Dann J. Hekman Adam M. Nicholson Michael R. Lasarev Roxana Alexandridis Benjamin H. Schnapp |
| author_facet | Corlin M. Jewell Guangyu (Anthony) Bai Dann J. Hekman Adam M. Nicholson Michael R. Lasarev Roxana Alexandridis Benjamin H. Schnapp |
| author_sort | Corlin M. Jewell |
| collection | DOAJ |
| description | Introduction: Patients seen per hour (PPH) is a popular metric for emergency medicine (EM) resident efficiency, although it is likely insufficient for encapsulating overall efficiency. In this study we explored the relationship between higher patient complexity, acuity on shift, and markers of clinical efficiency. Methods: We performed a retrospective analysis using electronic health record data of the patients seen by EM residents during their final year of training who graduated between 2017–2020 at a single, urban, academic hospital. We compared the number of PPH seen during the third (final) year to patient acuity (Emergency Severity Index), complexity (Current Procedural Terminology codes [CPT]), propensity for admissions, and generated relative value units (RVU). Results: A total of 46 residents were included in the analysis, representing 178,037 total cases. The number of PPH increased from first to second year of residency and fell slightly during the third year of residency. Overall, for each 50% increase in the odds of treating a patient requiring high-level evaluation and management (CPT code 99215), there was a 7.4% decrease in mean PPH. Each 50% increase in odds of treating a case requiring hospital admission was associated with a 6.7% reduction (95% confidence interval [CI] 0.73–12%; P = 0.03) in mean PPH. Each 0.1-point increase in PPH was associated with a 262 (95% CI 157–367; P < 0.001) unit increase in average RVUs generated. Conclusion: Seeing a greater number of patients per hour was associated with a lower volume of complex patients and patients requiring admission among EM residents. |
| format | Article |
| id | doaj-art-5e8ce2d4d7d14aafb08917ee0c088a93 |
| institution | OA Journals |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-5e8ce2d4d7d14aafb08917ee0c088a932025-08-20T02:10:28ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182025-01-0126225426010.5811/westjem.2028220282Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower ComplexityCorlin M. Jewell0Guangyu (Anthony) Bai1Dann J. Hekman2Adam M. Nicholson3Michael R. Lasarev4Roxana Alexandridis5Benjamin H. Schnapp6University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, WisconsinIndiana University School of Medicine-Northwest, Gary, IndianaUniversity of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, WisconsinUniversity of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, WisconsinUniversity of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WisconsinUniversity of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WisconsinUniversity of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, WisconsinIntroduction: Patients seen per hour (PPH) is a popular metric for emergency medicine (EM) resident efficiency, although it is likely insufficient for encapsulating overall efficiency. In this study we explored the relationship between higher patient complexity, acuity on shift, and markers of clinical efficiency. Methods: We performed a retrospective analysis using electronic health record data of the patients seen by EM residents during their final year of training who graduated between 2017–2020 at a single, urban, academic hospital. We compared the number of PPH seen during the third (final) year to patient acuity (Emergency Severity Index), complexity (Current Procedural Terminology codes [CPT]), propensity for admissions, and generated relative value units (RVU). Results: A total of 46 residents were included in the analysis, representing 178,037 total cases. The number of PPH increased from first to second year of residency and fell slightly during the third year of residency. Overall, for each 50% increase in the odds of treating a patient requiring high-level evaluation and management (CPT code 99215), there was a 7.4% decrease in mean PPH. Each 50% increase in odds of treating a case requiring hospital admission was associated with a 6.7% reduction (95% confidence interval [CI] 0.73–12%; P = 0.03) in mean PPH. Each 0.1-point increase in PPH was associated with a 262 (95% CI 157–367; P < 0.001) unit increase in average RVUs generated. Conclusion: Seeing a greater number of patients per hour was associated with a lower volume of complex patients and patients requiring admission among EM residents.https://escholarship.org/uc/item/5wg3g98h |
| spellingShingle | Corlin M. Jewell Guangyu (Anthony) Bai Dann J. Hekman Adam M. Nicholson Michael R. Lasarev Roxana Alexandridis Benjamin H. Schnapp Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity Western Journal of Emergency Medicine |
| title | Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity |
| title_full | Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity |
| title_fullStr | Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity |
| title_full_unstemmed | Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity |
| title_short | Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity |
| title_sort | harder better faster stronger residents seeing more patients per hour see lower complexity |
| url | https://escholarship.org/uc/item/5wg3g98h |
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