Tortoise or Hare – Which Resident Wins?

May 30, 2017

Short Attention Span Summary

Tortoise or hare – which resident wins?
Neither one.  This study of EM resident productivity found that the number of patients seen in the peak hour correlated with the number of patients seen in total.  But a higher number of patients in the peak hour meant a lower number of patients per hour for the remainder of the shift.  The average number of patients per 8-hour shift was 10.  They suggest a steadier work pace would result in a greater total number of patients per shift.  Wouldn’t that be nice!  With variable success, I try to embrace the inevitable peaks in volume, power through them, and push myself on the rest of the shift.  Aim to combine the best of the tortoise and the hare – always making forward progress and able to sprint when you need to.

Spoon Feed
The ED workflow has unavoidable peak hours in volume.  The key is improving off-peak hours by pushing ourselves to see new patients while managing existing ones.

Source
Do Slow and Steady Residents Win the Race? Modeling the Effects of Peak and Overall Resident Productivity in the Emergency Department.
J Emerg Med. 2017 Apr 12. pii: S0736-4679(17)30231-7. doi: 10.1016/j.jemermed.2017.03.019. [Epub ahead of print]

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Peer Reviewer Comments
I agree with the authors’ hypothesis that when residents pick up a bolus of patients early in their shifts, task switching increases. This subsequently limits productivity later in the shift. However, there may be another rate limiting step.  After a busy first couple hours when beds are plentiful, the emergency department may be filled up with patients requiring lengthy and complex workups.