PMID- 25493151
OWN - NLM
STAT- MEDLINE
DCOM- 20150818
LR  - 20240324
IS  - 1936-9018 (Electronic)
IS  - 1936-900X (Print)
IS  - 1936-900X (Linking)
VI  - 15
IP  - 7
DP  - 2014 Nov
TI  - Impact of a physician-in-triage process on resident education.
PG  - 902-7
LID - 10.5811/westjem.2014.9.22859 [doi]
AB  - INTRODUCTION: Emergency department (ED) crowding negatively impacts patient care 
      quality and efficiency. To reduce crowding many EDs use a physician-in-triage 
      (PIT) process. However, few studies have evaluated the effect of a PIT processes 
      on resident education. Our objective was to determine the impact of a PIT process 
      implementation on resident education within the ED of an academic medical center. 
      METHODS: We performed a prospective cross-sectional study for a 10-week period 
      from March to June 2011, during operationally historic trended peak patient 
      volume and arrival periods. Emergency medicine residents (three-year program) and 
      faculty, blinded to the research objectives, were asked to evaluate the 
      educational quality of each shift using a 5-point Likert scale. Residents and 
      faculty also completed a questionnaire at the end of the study period assessing 
      the perceived impact of the PIT process on resident education, patient care, 
      satisfaction, and throughput. We compared resident and attending data using 
      Mann-Whitney U tests. RESULTS: During the study period, 54 residents and 
      attendings worked clinically during the PIT process with 78% completing 
      questionnaires related to the study. Attendings and residents indicated "no 
      impact" of the PIT process on resident education [median Likert score of 3.0, 
      inter-quartile range (IQR): 2-4]. There was no difference in attending and 
      resident perceptions (p-value =0.18). Both groups perceived patient satisfaction 
      to be "positively impacted" [4.0, IQR:2-4 for attendings vs 4.0, IQR:1-5 for 
      residents, p-value =0.75]. Residents perceived more improvement in patient 
      throughput to than attendings [3.5, IQR:3-4 for attendings vs 4.0, IQR:3-5 for 
      residents, p-value =0.006]. Perceived impact on differential diagnosis generation 
      was negative in both groups [2.0, IQR:1-3 vs 2.5, IQR:1-5, p-value = 0.42]. The 
      impact of PIT on selection of diagnostic studies and medical decision making was 
      negative for attendings and neutral for residents: [(2.0, IQR:1-3 vs 3.0, 
      IQR:1-4, p-value =0.10) and (2.0, IQR:1-4 vs 3.0, IQR:1-5, p-value =0.14 
      respectively]. CONCLUSION: Implementation of a PIT process at an academic medical 
      center was not associated with a negative (or positive) perceived impact on 
      resident education. However, attendings and residents felt that differential 
      diagnosis development was negatively impacted. Attendings also felt diagnostic 
      test selection and medical decision-making learning were negatively impacted by 
      the PIT process.
FAU - Nicks, Bret A
AU  - Nicks BA
AD  - Wake Forest University Health Sciences, Department of Emergency Medicine, 
      Winston-Salem, North Carolina.
FAU - Mahler, Simon
AU  - Mahler S
AD  - Wake Forest University Health Sciences, Department of Emergency Medicine, 
      Winston-Salem, North Carolina.
FAU - Manthey, David
AU  - Manthey D
AD  - Wake Forest University Health Sciences, Department of Emergency Medicine, 
      Winston-Salem, North Carolina.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20140918
PL  - United States
TA  - West J Emerg Med
JT  - The western journal of emergency medicine
JID - 101476450
SB  - IM
MH  - Academic Medical Centers
MH  - Attitude of Health Personnel
MH  - Cross-Sectional Studies
MH  - Crowding
MH  - Emergency Medicine/*education
MH  - Emergency Service, Hospital/*organization & administration
MH  - Humans
MH  - *Internship and Residency
MH  - North Carolina
MH  - Patient Satisfaction
MH  - Prospective Studies
MH  - Quality of Health Care
MH  - Surveys and Questionnaires
MH  - Triage/*methods/organization & administration
PMC - PMC4251252
EDAT- 2014/12/11 06:00
MHDA- 2015/08/19 06:00
PMCR- 2014/11/01
CRDT- 2014/12/11 06:00
PHST- 2014/06/13 00:00 [received]
PHST- 2014/07/24 00:00 [revised]
PHST- 2014/09/02 00:00 [accepted]
PHST- 2014/12/11 06:00 [entrez]
PHST- 2014/12/11 06:00 [pubmed]
PHST- 2015/08/19 06:00 [medline]
PHST- 2014/11/01 00:00 [pmc-release]
AID - wjem-15-902 [pii]
AID - 10.5811/westjem.2014.9.22859 [doi]
PST - ppublish
SO  - West J Emerg Med. 2014 Nov;15(7):902-7. doi: 10.5811/westjem.2014.9.22859. Epub 
      2014 Sep 18.