Do Slow and Steady Residents Win the Race? Modeling the Effects of Peak and Overall Resident Productivity in the Emergency Department

Background: Emergency medicine residents need to be staffed in a way that balances operational needs with their educational experience. Key to developing an optimal schedule is knowing a resident's expected productivity, a poorly understood metric. Objective: We sought to measure how a resident's busiest (peak) workload affects their overall productivity for the shift. Methods: We conducted a retrospective, observational study of resident productivity at an urban, tertiary care center with a 3-year Accreditation Council for Graduate Medical Education-approved emergency medicine training program, with 55,000 visits annually. We abstracted resident productivity data from a database of patient assignments from July 1, 2010 to June 20, 2015, utilizing a generalized estimation equation method to evaluate physician shifts. Our primary outcome measure was the total number of patients seen by a resident over a shift. The secondary outcome was the number of patients seen excluding those in the peak hour. Results: A total of 14,361 shifts were evaluated. Multivariate analysis showed that the total number of patients seen was significantly associated with the number of patients seen during the peak hour, level of training, the timing of the shift, but most prominently, lower variance in patients seen per hour (coefficient of variation < 0.10). Conclusions: A resident's peak productivity can be a strong predictor of their overall productivity, but the substantial negative effect of variability favors a steadier pace. This suggests that resident staffing and patient assignments should generally be oriented toward a more consistent workload, an effect that should be further investigated with attending physicians. (C) 2017 Elsevier Inc. All rights reserved.