In patients presenting to the ED with headache or back pain, very few return with serious, missed diagnoses after the initial evaluation. Patient who are elderly, immunocompromised, or have preexisting neurologic disease were at greater risk of missing serious conditions.
With ED boarding, the burden of sign-out patients is greater than ever. This study shows just what I expected. All of these sign-out patients negatively affects how many new cases each resident is able to see on each shift.
Attending physician productivity peaks at the beginning of the shift, starting with about 3 new patients in the first hour and decreases as the shift progresses. This has important implications for staffing models. Assuming a simple, uniform average over the shift won't work.