Impact of Medical Residency Programs on Emergency Department Efficiency
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Data Collection
2.3. Outcome Measurement
2.4. Statistical Analysis
3. Results
3.1. ED with a Medical Residency Program Versus ED Staffed Only by Attending Physicians Before the Strike
3.2. Before Versus During the Strike in the Two EDs
3.3. ED with a Medical Residency Program Versus ED Staffed Only by Attending Physicians During the Strike
3.4. Patients Who Were Admitted to the ICU
3.5. Clinical Flow in Both EDs Before and During Strike
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
ED with a Medical Residents | ED Staffed Only by Attending Physicians | |||||
---|---|---|---|---|---|---|
Variable | Before the Strike (n = 560) | During the Strike (n = 515) | p-Value | Before the Strike (n = 338) | During the Strike (n = 404) | p-Value |
Door to first encounter (min) | 5.0 (2.0–9.0) | 10.0 (5.0–21.0) | <0.001 | 2.0 (1.0–4.0) | 2.0 (1.0–3.0) | <0.001 |
Door to order (min) | 8.0 (3.0–13.0) | 9.0 (5.0–15.0) | <0.001 | 7.0 (3.0–12.0) | 8.0 (5.0–11.0) | 0.270 |
CT order | 282 (50.4) | 213 (41.4) | 0.004 | 135 (39.9) | 203 (50.2) | 0.006 |
Door to CT order (min) | 74.0 (27.0–111.0) | 60.0 (23.0–91.0) | 0.007 | 43.0 (15.0–86.5) | 35.0 (9.0–92.0) | 0.303 |
Intubation | 108 (19.3) | 101 (19.6) | 0.954 | 27 (8.0) | 52 (12.9) | 0.043 |
Door to intubation (min) | 60.0 (26.0–143.5) | 38.0 (19.0–154.0) | 0.118 | 52.0 (27.0–172.0) | 64.5 (28.5–165.0) | 0.984 |
Central catheter insertion | 190 (33.9) | 158 (30.7) | 0.284 | 41 (12.1) | 56 (13.9) | 0.557 |
Door to central catheter insertion (min) | 80.5 (37.0–203.0) | 138.0 (36.0–246.0) | 0.073 | 212.0 (98.0–363.0) | 223.0 (120.5–311.0) | 0.962 |
Arterial catheter insertion | 360 (64.3) | 340 (66.0) | 0.595 | 119 (35.2) | 213 (52.7) | <0.001 |
Door to arterial catheter insertion (min) | 98.0 (37.5–294.0) | 140.5 (29.0–309.5) | 0.922 | 218.0 (73.0–363.0) | 174.0 (70.0–316.0) | 0.282 |
Door to decision (min) | 171.5 (83.0–280.0) | 117.0 (66.0–175.5) | <0.001 | 108.0 (64.0–176.0) | 100.0 (52.0–167.5) | 0.279 |
ED length of stay (min) | 247.5 (151.5–351.5) | 175.0 (117.5–238.0) | <0.001 | 189.5 (123.0–257.0) | 157.0 (97.0–232.5) | 0.001 |
Hospital length of stay (d) | 12.0 (5.0–31.0) | 12.0 (6.0–25.0) | 0.855 | 8.0 (4.0–16.0) | 10.0 (5.0–20.0) | 0.016 |
In-hospital mortality | 85 (15.2) | 80 (15.5) | 0.939 | 27 (8.0) | 48 (11.9) | 0.103 |
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Variable | ED with a Medical Residency Program (n = 16,773) | ED Staffed Only by Attending Physicians (n = 10,162) | p-Value |
---|---|---|---|
Age (years) | 53.0 (32.0–70.0) | 49.0 (35.0–65.0) | <0.001 |
Sex (male) | 7298 (43.5) | 4191 (41.2) | <0.001 |
Triage level | <0.001 | ||
Levels 1 and 2 | 453 (2.7) | 597 (5.9) | |
Levels 3 to 5 | 16,320 (97.3) | 9565 (94.1) | |
Door to first encounter (min) | 7.0 (4.0–12.0) | 3.0 (1.0–5.0) | <0.001 |
Door to order (min) | 15.0 (9.0–23.0) | 9.0 (5.0–13.0) | <0.001 |
CT order | 4292 (25.6) | 2734 (26.9) | 0.018 |
Door to CT order (min) | 73.5 (23.0–115.0) | 59.0 (15.0–98.0) | <0.001 |
1st consultation | 7605 (45.3) | 1744 (17.2) | <0.001 |
Door to consultation (min) | 95.0 (42.0–146.0) | 72.0 (27.0–124.0) | <0.001 |
Door to specialist arrival (min) | 156.0 (90.0–238.0) | 117.0 (63.0–176.0) | <0.001 |
2nd consultation | 668 (4.0) | 56 (0.6) | <0.001 |
Door to consultation (min) | 183.5 (126.0–251.5) | 148.5 (88.0–201.5) | 0.005 |
Door to specialist arrival (min) | 283.0 (201.0–398.5) | 206.0 (143.5–335.0) | 0.004 |
3rd consultation | 59 (0.4) | 0 | |
Door to consultation (min) | 202 (143.5–307.5) | 0 | |
Door to specialist arrival (min) | 329 (228.0–510.5) | 0 | |
4th consultation | 11 (0.1) | 0 | |
Door to consultation (min) | 298 (197–346.5) | 0 | |
Door to specialist arrival (min) | 396 (370.5–490.0) | 0 | |
Door to decision (min) | 134.0 (70.0–208.0) | 92.0 (32.0–139.0) | <0.001 |
ED length of stay (min) | 165.0 (95.0–260.0) | 116.0 (49.0–174.0) | <0.001 |
Disposition | <0.001 | ||
Discharge | 10,410 (62.0) | 6405 (63.0) | |
Admission to general ward | 3064 (18.3) | 1857 (18.3) | |
Admission to ICU | 560 (3.3) | 338 (3.3) | |
Transfer | 1947 (11.6) | 1492 (14.7) | |
Death | 42 (0.2) | 21 (0.2) | |
Against discharge | 750 (4.5) | 49 (0.5) |
ED with a Medical Residency Program | ED Staffed Only by Attending Physicians | |||||
---|---|---|---|---|---|---|
Variable | Before the Strike (n = 16,773) | During the Strike (n = 8172) | p-Value | Before the Strike (n = 10,162) | During the Strike (n = 9705) | p-Value |
Age (years) | 53.0 (32.0–70.0) | 60.0 (37.0–76.0) | <0.001 | 49.0 (35.0–65.0) | 53.0 (36.0–68.0) | <0.001 |
Sex (male) | 7298 (43.5) | 3816 (46.7) | <0.001 | 4191 (41.2) | 4239 (43.7) | <0.001 |
Triage level | <0.001 | <0.001 | ||||
Levels 1 and 2 | 453 (2.7) | 506 (6.2) | 597 (5.9) | 884 (9.1) | ||
Levels 3 to 5 | 16,320 (97.3) | 7666 (93.8) | 9565 (94.1) | 8821 (90.9) | ||
Door to first encounter (min) | 7.0 (4.0–12.0) | 14.0 (8.0–26.0) | <0.001 | 3.0 (1.0–5.0) | 2.0 (1.0–4.0) | <0.001 |
Door to order (min) | 15.0 (9.0–23.0) | 16.0 (10.0–25.0) | <0.001 | 9.0 (5.0–13.0) | 11.0 (7.0–15.0) | <0.001 |
CT order | 4292 (25.6) | 2974 (36.4) | <0.001 | 2734 (26.9) | 3352 (34.5) | <0.001 |
Door to CT order (min) | 73.5 (23.0–115.0) | 45.0 (18.0–96.0) | <0.001 | 59.0 (15.0–98.0) | 44.0 (13.0–98.0) | 0.001 |
1st consultation | 7605 (45.3) | 3692 (45.2) | <0.001 | 1744 (17.2) | 1904 (19.6) | <0.001 |
Door to consultation (min) | 95.0 (42.0–146.0) | 102.0 (54.0–148.0) | <0.001 | 72.0 (27.0–124.0) | 70.0 (25.0–122.0) | 0.237 |
Door to specialist arrival (min) | 156.0 (90.0–238.0) | 132.0 (84.0–185.0) | <0.001 | 117.0 (63.0–176.0) | 118.0 (66.0–179.0) | 0.591 |
Door to decision (min) | 134.0 (70.0–208.0) | 134.0 (90.0–188.0) | 0.011 | 92.0 (32.0–139.0) | 108.0 (64.0–151.0) | <0.001 |
ED length of stay (min) | 165.0 (95.0–260.0) | 162.0 (114.0–224.0) | 0.364 | 116.0 (49.0–174.0) | 133.0 (90.0–191.0) | <0.001 |
Disposition | <0.001 | <0.001 | ||||
Discharge | 10,410 (62.0) | 5316 (65.0) | 6405 (63.0) | 7005 (72.2) | ||
Admission to general ward | 3064 (18.3) | 2055 (25.1) | 1857 (18.3) | 2130 (21.9) | ||
Admission to ICU | 560 (3.3) | 515 (6.3) | 338 (3.3) | 404 (4.2) | ||
Transfer | 1947 (11.6) | 118 (1.4) | 1492 (14.7) | 91 (0.9) | ||
Death | 42 (0.2) | 25 (0.3) | 21 (0.2) | 27 (0.3) | ||
Against discharge | 750 (4.5) | 143 (1.7) | 49 (0.5) | 48 (0.5) |
Variable | ED with a Medical Residency Program (n = 8172) | ED Staffed Only by Attending Physicians (n = 9705) | p-Value |
---|---|---|---|
Age (years) | 60.0 (37.0–76.0) | 53.0 (36.0–68.0) | <0.001 |
Sex (male) | 3816 (46.7) | 4239 (43.7) | <0.001 |
Triage level | <0.001 | ||
Levels 1 and 2 | 506 (6.2) | 884 (9.1) | |
Levels 3 to 5 | 7666 (93.8) | 8821 (90.9) | |
Door to first encounter (min) | 14.0 (8.0–26.0) | 2.0 (1.0–4.0) | <0.001 |
Door to order (min) | 16.0 (10.0–25.0) | 11.0 (7.0–15.0) | <0.001 |
CT order | 2974 (36.4) | 3352 (34.5) | 0.01 |
Door to CT order (min) | 45.0 (18.0–96.0) | 44.0 (13.0–98.0) | <0.001 |
1st consultation | 3692 (45.2) | 1904 (19.6) | <0.001 |
Door to consultation (min) | 102.0 (54.0–148.0) | 70.0 (25.0–122.0) | <0.001 |
Door to specialist arrival (min) | 132.0 (84.0–185.0) | 118.0 (66.0–179.0) | <0.001 |
Door to decision (min) | 134.0 (90.0–188.0) | 108.0 (64.0–151.0) | <0.001 |
ED length of stay (min) | 162.0 (114.0–224.0) | 133.0 (90.0–191.0) | <0.001 |
Disposition | <0.001 | ||
Discharge | 5316 (65.0) | 7005 (72.2) | |
Admission to general ward | 2055 (25.1) | 2130 (21.9) | |
Admission to ICU | 515 (6.3) | 404 (4.2) | |
Transfer | 118 (1.4) | 91 (0.9) | |
Death | 25 (0.3) | 27 (0.3) | |
Against discharge | 143 (1.7) | 48 (0.5) |
Before the Strike | During the Strike | |||||
---|---|---|---|---|---|---|
Variable | ED with a Medical Residency Program (n = 560) | ED Staffed Only by Attending Physicians (n = 338) | p-Value | ED with a Medical Residency Program (n = 515) | ED Staffed Only by Attending Physicians (n = 404) | p-Value |
Door to first encounter (min) | 5.0 (2.0–9.0) | 2.0 (1.0–4.0) | <0.001 | 10.0 (5.0–21.0) | 2.0 (1.0–3.0) | <0.001 |
Door to order (min) | 8.0 (3.0–13.0) | 7.0 (3.0–12.0) | 0.146 | 9.0 (5.0–15.0) | 8.0 (5.0–11.0) | <0.001 |
CT order | 282 (50.4) | 135 (39.9) | 0.003 | 213 (41.4) | 203 (50.2) | 0.009 |
Door to CT order (min) | 74.0 (27.0–111.0) | 43.0 (15.0–86.5) | <0.001 | 60.0 (23.0–91.0) | 35.0 (9.0–92.0) | 0.003 |
Intubation | 108 (19.3) | 27 (8.0) | <0.001 | 101 (19.6) | 52 (12.9) | 0.008 |
Door to intubation (min) | 60.0 (26.0–143.5) | 52.0 (27.0–172.0) | 0.867 | 38.0 (19.0–154.0) | 64.5 (28.5–165.0) | 0.189 |
Central catheter insertion | 190 (33.9) | 41 (12.1) | <0.001 | 158 (30.7) | 56 (13.9) | <0.001 |
Door to central catheter insertion (min) | 80.5 (37.0–203.0) | 212.0 (98.0–363.0) | <0.001 | 138.0 (36.0–246.0) | 223.0 (120.5–311.0) | 0.001 |
Arterial catheter insertion | 360 (64.3) | 119 (35.2) | <0.001 | 340 (66.0) | 213 (52.0) | <0.001 |
Door to arterial catheter insertion (min) | 98.0 (37.5–294.0) | 218.0 (73.0–363.0) | 0.001 | 140.5 (29.0–309.5) | 174.0 (70.0–316.0) | 0.014 |
Door to decision (min) | 171.5 (83.0–280.0) | 108.0 (64.0–176.0) | <0.001 | 117.0 (66.0–175.5) | 100.0 (52.0–167.5) | 0.011 |
ED length of stay (min) | 247.5 (151.5–351.5) | 189.5 (123.0–257.0) | <0.001 | 175.0 (117.5–238.0) | 157.0 (97.0–232.5) | 0.014 |
Hospital length of stay (d) | 12.0 (5.0–31.0) | 8.0 (4.0–16.0) | <0.001 | 12.0 (6.0–25.0) | 10.0 (5.0–20.0) | 0.003 |
In-hospital mortality | 85 (15.2) | 27 (8.0) | 0.002 | 80 (15.5) | 48 (11.9) | 0.136 |
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Share and Cite
Namgung, M.; Bae, S.J.; Chung, H.S.; Jung, K.Y.; Choi, Y.H.; Kim, C.W.; Gong, Y.L.; Lee, J.Y.; Lee, D.-H. Impact of Medical Residency Programs on Emergency Department Efficiency. Medicina 2025, 61, 999. https://doi.org/10.3390/medicina61060999
Namgung M, Bae SJ, Chung HS, Jung KY, Choi YH, Kim CW, Gong YL, Lee JY, Lee D-H. Impact of Medical Residency Programs on Emergency Department Efficiency. Medicina. 2025; 61(6):999. https://doi.org/10.3390/medicina61060999
Chicago/Turabian StyleNamgung, Myeong, Sung Jin Bae, Ho Sub Chung, Kwang Yul Jung, Yun Hyung Choi, Chan Woong Kim, Ye Lim Gong, Ji Yun Lee, and Dong-Hoon Lee. 2025. "Impact of Medical Residency Programs on Emergency Department Efficiency" Medicina 61, no. 6: 999. https://doi.org/10.3390/medicina61060999
APA StyleNamgung, M., Bae, S. J., Chung, H. S., Jung, K. Y., Choi, Y. H., Kim, C. W., Gong, Y. L., Lee, J. Y., & Lee, D.-H. (2025). Impact of Medical Residency Programs on Emergency Department Efficiency. Medicina, 61(6), 999. https://doi.org/10.3390/medicina61060999