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

Area of Science:

• Emergency Medicine
• Health Services Research
• Medical Education

Background:

• Patient chief complaint is a primary factor in emergency department (ED) triage and physician assignment.
• Understanding factors influencing resident physician patient selection is crucial for optimizing ED workflow and training.

Purpose of the Study:

• To evaluate the association between patient chief complaint and the time interval between patient rooming and resident physician self-assignment (pickup time).
• To hypothesize that significant variation in pickup time exists based on chief complaint, potentially revealing resident preferences.

Main Methods:

• Retrospective review of electronic health records for over 30,000 patients in a university-based ED.
• Analysis of "pickup time" (room assignment to resident self-assignment) for patients seen by residents.
• Proportional hazards model used to control for demographic and clinical factors.

Main Results:

• Median pickup time was 6 minutes (IQR 2-15 minutes).
• Significant variation in pickup time by chief complaint was observed after controlling for covariates.
• Longest pickup times were associated with abdominal problems, numbness/tingling, and vaginal bleeding; shortest times were for ankle injury, allergic reaction, and wrist injury.

Conclusions:

• Consistent variation in resident pickup time by chief complaint suggests residents may prefer patients with simpler workups.
• Pickup time can serve as a metric to uncover and address potential physician bias.
• Further research is needed to determine if these patterns persist in attending physicians and are influenced by EHR information.