Resident productivity: trends over consecutive shifts

BACKGROUND: It has been shown that residents’ ability to see more patients and patients of higher acuity improves with level of training. AIMS: No published study has reviewed whether residents become less productive with consecutive shifts. Determining peak resident productivity can optimize staffing to manage patient flow and enhance resident exposure to patients, which is critical to their education. We examine the relationship between resident productivity and number of consecutive shifts worked. METHODS: This is a retrospective review of emergency medicine (EM) resident productivity defined as patients evaluated per hour per shift. Data were collected utilizing patient tracker software which provides a record of physician assignment and checked against the computerized medical record. Residents were credited with a patient if they initiated the workup and dictated the chart. Productivity was tallied for 188 first-year shift strings, 303 second-year shift strings, and 224 third-year shift strings beginning 1 November 2006. Analysis of variance (ANOVA) was used to assess for productivity differences based on the shift number, with the first shift in a series being designated “1,” the second consecutive shift being designated “2,” and so on. RESULTS: First-year residents saw 0.82, 0.81, and 0.91 patients per hour on consecutive shifts (F((2,175))=2.89, p = 0.06), second-year residents saw 1.12, 1.08, 1.17, and 1.28 patients per hour on consecutive shifts (F((3,292))=4.19, p = 0.006), and third-year residents saw 1.19, 1.24, and 1.33 patients per hour on consecutive shifts (F((2,211))=4.08, p = 0.02). CONCLUSIONS: Instead of tiring, residents maintain or improve productivity over consecutive shifts.