Khalid Bashir, Ashid Kodumayil, Saleem Farook, Sameer Pathan, Thirmoorthy samy Kumar, Abdllatif AlKahl, Dominic Jenkins, Stephen Thomas


Background: The length of stay (LOS) is an important operational parameter closely followed in emergency department (ED).  This study aims to assess operations impacts of a large post-residency EM Fellowship (EMF) program on LOS. Methods: This was a retrospective database analysis of data collected automatically by the study ED’s electronic medical record (EMR) for one full academic year, starting in September 2016. The main dependent variable was LOSfor the cases discharged after EM-only evaluation (LOSDCEM), and the independent variable of interest was the proportion of EMFs as a % of all on-duty ED physicians during the shift the patient presented. Results: During the study period, the ED census for patients discharged after EM-only evaluation was 327,527. Exclusion of 5,803 EMR-downtime cases (1.8% of 327,527) and 845 (0.3% of 327,527) cases with LOS exceeding 24 hours, the final study set comprised 320,879 LOSDCEM cases. The EMF proportion of on-duty ED physicians, was statistically significant at the lowest three τ levels but not significant at the higher six τ levels. For the 10th, 20th, and 30th percentiles of LOSDCEM, the % relative improvements in LOSDCEM achieved by increasing the EMF proportion 1% were, respectively, 13% (6.5/52), 8% (6.8/83), and 7% (8.1/115). Conclusion: The LOSDCEM does not appear to be unfavourably impacted by increasing the proportion of EMFs as a % of all on-duty ED physicians. The EMFs numbers (as a percentage of all on-duty physicians) disproportionately improves LOSDCEM for those patients with shorter LOS.

Keywords: Emergency department; Operation parameters: Length-of-stay; Trainees; EM fellowship; Emergency Medicine Fellowship

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Pathan SA, Baroudi OA, Rahman ZH, Saleh WA, Thomas SW, Jenkins D, et al. Electronic medical record error in reported time of discharge: A prospective analysis at a tertiary care hospital. Int J Healthc Manag 2020:1–8.

Pathan S, Bhutta Z, Moinudheen J, Jenkins D, Farook S, Qureshi I, et al. Partial replacement of board-certified specialist-grade physicians with emergency medicine trainees in a busy Emergency Department: Lack of adverse effect on time-to-physician. J Emerg Med Trauma Acute Care 2017;2017(1):7.

Pathan SA, Bhutta ZA, Moinudheen J, Jenkins D, Silva AD, Sharma Y, et al. Marginal analysis in assessing factors contributing time to physician in the Emergency Department using operations data. Qatar Med J 2016;2016(2):18.

Elkum NB, Barrett C, Al-Omran H. Canadian Emergency Department Triage and Acuity Scale: implementation in a tertiary care center in Saudi Arabia. BMC Emerg Med 2011;11:3.

Pielsticker S, Whelan L, Arthur A, Thomas SH. Identifying patient door-to-room goals that minimize left-without-being-seen rates. West J Emerg Med 2015;16(5):611.

Bucheli B, Martina B. Reduced length of stay in medical emergency department patients: a prospective controlled study on emergency physician staffing. Eur J Emerg Med 2004;11(1):29–34.

Soremekun OA, Capp R, Biddinger PD, White BA, Chang Y, Carignan SB, et al. Impact of physician screening in the emergency department on patient flow. J Emerg Med 2012;43(3):509–15.

Xi W, Dalal V. Impact of Family Medicine Resident Physicians on Emergency Department Wait Times and Patients Leaving Without Being Seen. Can J Emerg Med 2015;17(5):475–83.

Whelan L, Burns B, Brantley M, Haas T, Arthur AO, Thomas SH. Mathematical modeling of the impact of hospital occupancy: When do dwindling hospital beds cause ED gridlock? Adv Emerg Med 2014;2014:5.

Rodriquez RN, Yao Y. SAS Paper 525-2017: Five things you should know about quantile regression. In Proceeding of the SAS glonal forum 2017 conference: Orlando, 2017; p.2–5.


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