EM Residency and Patient Volume

[EM2013]

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I know that it's very important to see a high volume of pts during residency but I'm confused how to judge this.

I know we have access to the raw data but I'm confused how to judge the numbers because who knows how many of these people are coming in for intoxications, primary care issues, etc and are not actually emergent?

Are there any programs (specifically) that are known for having too low of a pt volume to make a good residency experience?

 

[RustedFox]

No.

 

[joeDO2]

denver health has a great article on "what to look for in an emergency medicine residency". It can be found here:

http://www.denverem.org/index.php?option=com_content&view=article&id=14&Itemid=36

They say anything above 30K visits should be adequate for volume. This isn't a problem for the vast majority of programs, although a few on the osteo side might come close. There are a bunch of other stats to consider as well though if you read the full article.

 

[UnderwaterDoc]

I think patients per hour (PPH) is a more important number than total volume. A couple of buddies are at a lower volume (~50K/year) place, but they end up seeing over 3 PPH because their program only takes 6 residents per class.

Where I'm at our total volume is ~85K/year, but our program takes 11 residents per class so we end up seeing closer to 2 PPH on an average shift.

I think any program where you are seeing 2-3PPH is more than adequate. You will learn to hate those shifts where you are seeing 3PPH or above.

 

[Cerberus]

PPH is misleading as well. Are there different areas of the ER divided by acuity? 3PPH is one thing when you are seeing Fast Track patients, it's another beast when you are seeing ESI 1-2s.

 

[strongboy2005]

Higher volume = higher raw number of sick people

So, hypothetically, one could have a hospital with a volume of 100k and 10 residents. Those 10 residents, let's say, work a combined 25,000 hours a year, see 2 PPH, for a total of 50,000 patients. Attendings, PAs/NPs, etc see the rest.

Now, another hospital with a 50k volume can have the same 10 residents seeing 2 PPH. Residents see all the patients.

On the surface, the residents at each program are indeed seeing 2 PPH. However, the 100k program has its residents seeing the top 50% sickest patients, while the 50k program has residents seeing everybody (not as many sick patients to go around). Same number of patients, different experience.

 

[ERDude]

PPH is misleading as well. Are there different areas of the ER divided by acuity? 3PPH is one thing when you are seeing Fast Track patients, it's another beast when you are seeing ESI 1-2s.

I will add to this. Any resident that claims to be seeing 3pph with any regularity is in one of 3 scenarios (I think).

- The attendings are actually doing a lot of the work (reviewing labs, taking reports, calling consultants, updating patients/families, perhaps even procedures) and the resident either ignores or doesn't recognize it.

- They are seeing a large percentage of fast-track patients

- They are full of ****.

I was one of the faster residents at my place and I honestly don't ever recall reaching 3pph (maybe once or twice but I probably didn't realize that my attending(s) picked up a good amount of the slack).

If you're a senior resident who thinks you can safely manage 3pph on average in a community ED without residents (where there will likely be a PA working fast track for most of the day) you will be in a for rude awakening if you take a job that actually requires that (I think anything significantly above 2pph can easily get unsafe for the majority of EPs).

 

[migm]

how hard could it be to come up with a pph or other rate that is standardized for acuity?

 

[Daiphon]

how hard could it be to come up with a pph or other rate that is standardized for acuity?

It's not. In the real world, it's called an RVU... problem is, it doesn't take into account the inherent waste associated with training programs (time spent discussing/educating, procedures, inefficiency, etc).

Now, come up with a validated residency RVU and you're in business.

I think, however, that the point is being missed. All programs, in order to be accredited, need to hit certain patient volume/acuity benchmarks. If the program is accredited, then don't worry. Training is about quality over quantity (until you get more advanced and quantity while providing quality is the name of the game).

Just my $0.02,
-d

Sent from my DROID BIONIC using Tapatalk

 

[deleted109597]

There were days in residency I saw 3 pph, but it was on the "low acuity" side. Of course, nurses could dictate what went over there, so we often had ectopics, DKA, a Boerhaave's, etc, but you usually admitted less than 10% on that side.
The high acuity side? Closer to 75-100% admit rate. Usually closer to 1.5-2pph. And you always felt rushed. I haven't felt that way since leaving that place.
Our shop saw 120K my last year, and since my attendings were basically slugs, residents saw every patient that didn't come in during protected conference time.
Of course, there were some shifts we had more than 10 residents working at the same time.


Truthfully, PPH is better than total number. The 30k shops likely just have 2 residents on at any given time. I know ours does. The ones with more, have more working. It's just a natural consequence.