The effect of batched patient–physician assignment on patient length of stay in the emergency department
Abstract Objectives Queuing theory suggests that signing up for multiple patients at once (batching) can negatively affect patients’ length of stay (LOS). At academic centers, resident assignment adds a second layer to this effect. In this study, we measured the rate of batched patient assignment by...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12784 |
| _version_ | 1828254496753451008 |
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| author | Bryan Imhoff Kenneth D. Marshall Joshua W. Joseph Nima Sarani Julie Kelman Niaman Nazir |
| author_facet | Bryan Imhoff Kenneth D. Marshall Joshua W. Joseph Nima Sarani Julie Kelman Niaman Nazir |
| author_sort | Bryan Imhoff |
| collection | DOAJ |
| description | Abstract Objectives Queuing theory suggests that signing up for multiple patients at once (batching) can negatively affect patients’ length of stay (LOS). At academic centers, resident assignment adds a second layer to this effect. In this study, we measured the rate of batched patient assignment by resident physicians, examined the effect on patient in‐room LOS, and surveyed residents on underlying drivers and perceptions of batching. Methods This was a retrospective study of discharged patients from August 1, 2020 to October 27, 2020, supplemented with survey data conducted at a large, urban, academic hospital with an emergency medicine training program in which residents self‐assign to patients. Time stamps were extracted from the electronic health record and a definition of batching was set based on findings of a published time and motion study. Results A total of 3794 patients were seen by 28 residents and ultimately discharged during the study period. Overall, residents batched 23.7% of patients, with a greater rate of batching associated with increasing resident seniority and during the first hour of resident shifts. In‐room LOS for batched assignment patients was 15.9 minutes longer than single assignment patients (P value < 0.01). Residents’ predictions of their rates of batching closely approximated actual rates; however, they underestimated the effect of batching on LOS. Conclusions Emergency residents often batch patients during signup with negative consequences to LOS. Moreover, residents significantly underestimate this negative effect. |
| first_indexed | 2024-04-13T01:59:45Z |
| format | Article |
| id | doaj.art-b628e53533ab4d15be26f81eb9ac5cc2 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-04-13T01:59:45Z |
| publishDate | 2022-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-b628e53533ab4d15be26f81eb9ac5cc22022-12-22T03:07:40ZengWileyJournal of the American College of Emergency Physicians Open2688-11522022-08-0134n/an/a10.1002/emp2.12784The effect of batched patient–physician assignment on patient length of stay in the emergency departmentBryan Imhoff0Kenneth D. Marshall1Joshua W. Joseph2Nima Sarani3Julie Kelman4Niaman Nazir5Department of Emergency Medicine University of Kansas Medical Center Kansas City KS USADepartment of Emergency Medicine University of Kansas Medical Center Kansas City KS USADepartment of Emergency Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USADepartment of Emergency Medicine University of Kansas Medical Center Kansas City KS USADepartment of Emergency Medicine Beth Israel Deaconess Medical Center Boston MA USADepartment of Population Health University of Kansas Medical Center Kansas City KS USAAbstract Objectives Queuing theory suggests that signing up for multiple patients at once (batching) can negatively affect patients’ length of stay (LOS). At academic centers, resident assignment adds a second layer to this effect. In this study, we measured the rate of batched patient assignment by resident physicians, examined the effect on patient in‐room LOS, and surveyed residents on underlying drivers and perceptions of batching. Methods This was a retrospective study of discharged patients from August 1, 2020 to October 27, 2020, supplemented with survey data conducted at a large, urban, academic hospital with an emergency medicine training program in which residents self‐assign to patients. Time stamps were extracted from the electronic health record and a definition of batching was set based on findings of a published time and motion study. Results A total of 3794 patients were seen by 28 residents and ultimately discharged during the study period. Overall, residents batched 23.7% of patients, with a greater rate of batching associated with increasing resident seniority and during the first hour of resident shifts. In‐room LOS for batched assignment patients was 15.9 minutes longer than single assignment patients (P value < 0.01). Residents’ predictions of their rates of batching closely approximated actual rates; however, they underestimated the effect of batching on LOS. Conclusions Emergency residents often batch patients during signup with negative consequences to LOS. Moreover, residents significantly underestimate this negative effect.https://doi.org/10.1002/emp2.12784administrationbatchingoperationsprovider assignmentthroughput |
| spellingShingle | Bryan Imhoff Kenneth D. Marshall Joshua W. Joseph Nima Sarani Julie Kelman Niaman Nazir The effect of batched patient–physician assignment on patient length of stay in the emergency department Journal of the American College of Emergency Physicians Open administration batching operations provider assignment throughput |
| title | The effect of batched patient–physician assignment on patient length of stay in the emergency department |
| title_full | The effect of batched patient–physician assignment on patient length of stay in the emergency department |
| title_fullStr | The effect of batched patient–physician assignment on patient length of stay in the emergency department |
| title_full_unstemmed | The effect of batched patient–physician assignment on patient length of stay in the emergency department |
| title_short | The effect of batched patient–physician assignment on patient length of stay in the emergency department |
| title_sort | effect of batched patient physician assignment on patient length of stay in the emergency department |
| topic | administration batching operations provider assignment throughput |
| url | https://doi.org/10.1002/emp2.12784 |
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