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Emergency department disposition: Do surgical residents contribute to inefficiency?
Crystal Siyu Zhang1, Larry Wang2, Jonathan Saxe1
1Ascension St. Vincent Hospital, 2001 W. 86th St, Indianapolis, IN, 46260, USA.
Background:
Residents are often viewed as contributors to Emergency Department (ED) prolongation of length of stay (LOS). To understand this proposition, we performed a study to identify ED patient care intervals and how each contributed to LOS.
Methods:
We performed a retrospective review of prospectively gathered data on 145 ED surgery consults. Residents prospectively documented patient names, page times, and time of plan. Key ED patient care intervals were then retrospectively extracted from the patient's chart. A time analysis was then performed.
Results:
Average arrival to disposition time was 305 min, and residents averaged 47 min to see and staff consults. The longest intervals were arrival to imaging (75 min) and imaging time (73 min). Average disposition to discharge time was 170 min (36% of LOS).
Conclusions:
Surgery residents see and staff consults within the norms for care established by the hospital. Imaging time is a bottleneck hindering disposition. Access block also significantly increases ED LOS.
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Cultural barriers:
Differences in values, beliefs, religion, knowledge, and tradition can significantly impact communication. Awareness of nonverbal cues is critical, especially when conversing with a patient from a different culture. What appears appropriate in one culture may be inappropriate in another.
Semantic barriers:
As a result of their tendency to use...