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Adding More Junior Residents May Worsen Emergency Department Crowding

BACKGROUND: Although increasing staff numbers during shifts when emergency department (ED) crowding is severe can help meet patient demand, it remains unclear how different types of added staff, particularly junior residents, may affect crowding. METHODS: To identify associations between types of st...

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Autores principales: Kawano, Takahisa, Nishiyama, Kei, Hayashi, Hiroyuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219696/
https://www.ncbi.nlm.nih.gov/pubmed/25369063
http://dx.doi.org/10.1371/journal.pone.0110801
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author Kawano, Takahisa
Nishiyama, Kei
Hayashi, Hiroyuki
author_facet Kawano, Takahisa
Nishiyama, Kei
Hayashi, Hiroyuki
author_sort Kawano, Takahisa
collection PubMed
description BACKGROUND: Although increasing staff numbers during shifts when emergency department (ED) crowding is severe can help meet patient demand, it remains unclear how different types of added staff, particularly junior residents, may affect crowding. METHODS: To identify associations between types of staff and ED crowding, we conducted a cross-sectional, single-center study in the ED of a large, teaching hospital in Japan between January and December 2012. Patients who visited the ED during the study period were enrolled. We excluded (1) patients previously scheduled to visit the ED, and (2) neonates transferred from other hospitals. During the study period, 27,970 patients were enrolled. Types of staff analyzed were junior (first and second year) residents, senior (third to fifth year) residents, attending (board-certified) physicians, and nurses. A generalized linear model was applied to length of ED stay for all patients as well as admitted and discharged patients to quantify an association with the additional staff. RESULTS: In the model, addition of one attending physician or senior resident was associated with decreased length of ED stay for total patients by 3.88 or 1.64 minutes, respectively (95% CI, 2.20–5.56 and 0.81–2.48 minutes); while additional nursing staff had no association. Surprisingly, however, one additional junior resident was associated with prolonged length of ED stay for total patients by 0.97 minutes (95% CI 0.37–1.57 minutes) and for discharged patients by 1.01 minutes (95% CI 0.45–1.59 minutes). CONCLUSION: Staffing adjustments aimed at alleviating ED crowding should focus on adding more senior staff during peak-volume shifts.
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spelling pubmed-42196962014-11-12 Adding More Junior Residents May Worsen Emergency Department Crowding Kawano, Takahisa Nishiyama, Kei Hayashi, Hiroyuki PLoS One Research Article BACKGROUND: Although increasing staff numbers during shifts when emergency department (ED) crowding is severe can help meet patient demand, it remains unclear how different types of added staff, particularly junior residents, may affect crowding. METHODS: To identify associations between types of staff and ED crowding, we conducted a cross-sectional, single-center study in the ED of a large, teaching hospital in Japan between January and December 2012. Patients who visited the ED during the study period were enrolled. We excluded (1) patients previously scheduled to visit the ED, and (2) neonates transferred from other hospitals. During the study period, 27,970 patients were enrolled. Types of staff analyzed were junior (first and second year) residents, senior (third to fifth year) residents, attending (board-certified) physicians, and nurses. A generalized linear model was applied to length of ED stay for all patients as well as admitted and discharged patients to quantify an association with the additional staff. RESULTS: In the model, addition of one attending physician or senior resident was associated with decreased length of ED stay for total patients by 3.88 or 1.64 minutes, respectively (95% CI, 2.20–5.56 and 0.81–2.48 minutes); while additional nursing staff had no association. Surprisingly, however, one additional junior resident was associated with prolonged length of ED stay for total patients by 0.97 minutes (95% CI 0.37–1.57 minutes) and for discharged patients by 1.01 minutes (95% CI 0.45–1.59 minutes). CONCLUSION: Staffing adjustments aimed at alleviating ED crowding should focus on adding more senior staff during peak-volume shifts. Public Library of Science 2014-11-04 /pmc/articles/PMC4219696/ /pubmed/25369063 http://dx.doi.org/10.1371/journal.pone.0110801 Text en © 2014 Kawano et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Kawano, Takahisa
Nishiyama, Kei
Hayashi, Hiroyuki
Adding More Junior Residents May Worsen Emergency Department Crowding
title Adding More Junior Residents May Worsen Emergency Department Crowding
title_full Adding More Junior Residents May Worsen Emergency Department Crowding
title_fullStr Adding More Junior Residents May Worsen Emergency Department Crowding
title_full_unstemmed Adding More Junior Residents May Worsen Emergency Department Crowding
title_short Adding More Junior Residents May Worsen Emergency Department Crowding
title_sort adding more junior residents may worsen emergency department crowding
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219696/
https://www.ncbi.nlm.nih.gov/pubmed/25369063
http://dx.doi.org/10.1371/journal.pone.0110801
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