Cherry Picking Patients: Examining the Interval Between Patient Rooming and Resident Self‐assignment

Objective We aimed to evaluate the association between patient chief complaint and the time interval between patient rooming and resident physician self‐assignment (“pickup time”). We hypothesized that significant variation in pickup time would exist based on chief complaint, thereby uncovering resi...

Full description

Saved in:
Bibliographic Details
Published in:Academic emergency medicine 2016-06, Vol.23 (6), p.679-684
Main Authors: Patterson, Brian W., Batt, Robert J., Wilbanks, Morgan D., Otles, Erkin, Westergaard, Mary C., Shah, Manish N., Asher, Shellie L.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Bias
Child
Child, Preschool
Complaints
Electronic health records
Emergency medical care
Emergency Service, Hospital - organization & administration
Female
Health care delivery
Hospitals, University - statistics & numerical data
Humans
Infant
Infant, Newborn
Internship and Residency - statistics & numerical data
Male
Middle Aged
Patient Acuity
Patients' Rooms - statistics & numerical data
Physician patient relationships
Proportional Hazards Models
Quality of care
Retrospective Studies
Severity of Illness Index
Sex Factors
Socioeconomic Factors
Time Factors
Time-to-Treatment - statistics & numerical data
Vital Signs
Waiting Lists
Young Adult
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective We aimed to evaluate the association between patient chief complaint and the time interval between patient rooming and resident physician self‐assignment (“pickup time”). We hypothesized that significant variation in pickup time would exist based on chief complaint, thereby uncovering resident preferences in patient presentations. Methods A retrospective medical record review was performed on consecutive patients at a single, academic, university‐based emergency department with over 50,000 visits per year. All patients who presented from August 1, 2012, to July 31, 2013, and were initially seen by a resident were included in the analysis. Patients were excluded if not seen primarily by a resident or if registered with a chief complaint associated with trauma team activation. Data were ed from the electronic health record (EHR). The outcome measured was “pickup time,” defined as the time interval between room assignment and resident self‐assignment. We examined all complaints with >100 visits, with the remaining complaints included in the model in an “other” category. A proportional hazards model was created to control for the following prespecified demographic and clinical factors: age, race, sex, arrival mode, admission vital signs, Emergency Severity Index code, waiting room time before rooming, and waiting room census at time of rooming. Results Of the 30,382 patients eligible for the study, the median time to pickup was 6 minutes (interquartile range = 2–15 minutes). After controlling for the above factors, we found systematic and significant variation in the pickup time by chief complaint, with the longest times for patients with complaints of abdominal problems, numbness/tingling, and vaginal bleeding and shortest times for patients with ankle injury, allergic reaction, and wrist injury. Conclusions A consistent variation in resident pickup time exists for common chief complaints. We suspect that this reflects residents preferentially choosing patients with simpler workups and less perceived diagnostic ambiguity. This work introduces pickup time as a metric that may be useful in the future to uncover and address potential physician bias. Further work is necessary to establish whether practice patterns in this study are carried beyond residency and persist among attendings in the community and how these patterns are shaped by the information presented via the EHR.
ISSN:1069-6563
1553-2712
DOI:10.1111/acem.12895