Emergency department resource use by supervised residents vs attending physicians alone

Area of Science:

• Health Services Research
• Medical Education
• Emergency Medicine

Background:

• Graduate medical education is often assumed to increase healthcare resource utilization.
• Limited research exists on the association between medical training and resource use in emergency departments (EDs).

Purpose of the Study:

• To compare resource utilization between supervised (resident and attending physician) and attending-only visits in US emergency departments.
• To investigate if the teaching intensity of an ED influences resource use during supervised visits.

Main Methods:

• Cross-sectional study using the 2010 National Hospital Ambulatory Medical Care Survey data.
• Defined supervised visits and categorized EDs into nonteaching, minor teaching, and major teaching based on the proportion of supervised visits.
• Analyzed associations between supervised visits and hospital admission, advanced imaging, blood tests, and ED length of stay, adjusting for covariates.

Main Results:

• Supervised visits were significantly associated with higher rates of hospital admission (aOR, 1.42) and advanced imaging use (aOR, 1.27), along with longer ED stays (1.32-fold increase).
• No significant association was found between supervised visits and blood testing.
• In major teaching EDs, supervised visits showed trends toward increased admission and imaging but were not statistically significant, though longer ED stays persisted.

Conclusions:

• Supervised visits in US emergency departments are associated with increased hospital admissions, advanced imaging use, and longer ED stays.
• The findings suggest that graduate medical education may contribute to higher resource utilization.
• Further investigation is warranted to understand resource use in major teaching EDs where residents see most patients.