Correlation of physician seniority with increased emergency department efficiency during a resident doctors' strike

Physician seniority has increasingly been shown to correlate with improved clinical outcomes. However few studies examine the relationship between treating doctor experience and the efficiency of emergency care systems. We explored the hypothesis that increased seniority of emergency department (ED) medical staff would result in improved ED efficiency.

This was prospective observational study conducted at the ED of Waikato Hospital, a 650-bed university-affiliated teaching hospital. All patient presentations during a 5-day resident doctors' strike when the ED was staffed by senior physicians, and the corresponding normally staffed days of the subsequent calendar week were examined. Patient waiting times, time seen to disposition, and total ED length of stay were recorded according to Australasian Triage Score (ATS).

608 and 683 patient presentations were recorded during the strike and non-strike period respectively. Waiting times were reduced for ATS3 (43.8 vs 73.6 minutes, p<0.001) and ATS4 (53.7 vs 82.0 minutes, p<0.001) during the strike period. Time seen to disposition were reduced for ATS2 (147.9 vs 255.1 minutes, p=0.001) and ATS3 (119.9 vs 165.0 minutes, p<0.001) during the strike period. ED length of stay was reduced for ATS2 (162.6 vs 278.6 minutes, p<0.001), ATS3 (161.9 vs 238.4 minutes, p<0.001), and ATS4 (134.1 vs 179.2 minutes, p<0.001) during the strike period. No difference was observed in patient walkout, ED mortality, 48-hour mortality, or 30-day unscheduled representation rates.

Increasing seniority of front line ED staff during a period of resident doctors' strike action was associated with increased efficiency of ED patient processing. Early specialist involvement with ED patients may replicate these efficiencies during periods of normal departmental operation.