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Work in progress: CORD/SAEM abstracts due Dec 2, 2009

Posted Nov 17 2009 10:04pm

The December 2 deadline is quickly approaching! Get your CORD and SAEM abstract submissions in. If accepted, many of these abstracts will be published in the Academic Emergency Medicine journal.

I am submitting my educational research study to CORD, since I will be there anyway to teach other educational activities. Also the CORD Academic Assembly is veritably the most education-centric national conference in EM. Our working abstract draft is shown below.

Bottom line of my abstract:
Overcrowding in the Emergency Department seems to correlate with decreased faculty teaching in the ED, according to the EDWIN crowding score. That means that teaching is negatively impacted by a crowded ED.

This crowded ED photo was captured from our ED at
San Francisco General Hospital. The SAEM folks liked
it so much that they featured it on their website as part
of their push to highlight crowding as a national crisis.



Impact of Overcrowding on Faculty Teaching Time
in the Emergency Department
Michelle Lin, MD
Christy Boscardin, PhD
Sandi Ma, MS
Bridget O’Brien, PhD

PURPOSE
Emergency Department (ED) crowding is known to result in delays in pain management and worse medical outcomes, but there are very few studies focusing on the impact of crowding on teaching. Survey-based studies report that crowding does not result in lower faculty teaching evaluation scores, contrary to anecdotal evidence. This study is the first prospective study objectively documenting whether attending physician teaching behavior changes as a function of crowding.

METHODS
A prospective, observational time-motion study was conducted at an urban, academic ED. During September-December 2008, 19 unique faculty members were observed during a 6-hour block while working in a zone with medical students and PGY-1 residents. A single observer documented attending physician behavior every 30 minutes for 15 consecutive minutes during the 6-hour period, yielding 12 discrete observation periods. Within each 15-minute period, attending behavior data were collected in 1-minute intervals as one of 6 outcome variable activities: direct patient care teaching (attending with learner and patient), indirect patient care teaching (attending with learner), direct non-teaching patient care (attending with patient), indirect non-teaching patient care (attending with other person), attending working alone, and personal time. Every 30 minutes, the same observer also recorded crowding variables. The predictor variable (crowding) and outcome variable (attending behavior) were calculated as a continuous variable for 12 observation points per shift. A repeated measures analysis of variance was performed with four predictor variables (number of years as an attending, EDWIN crowding score, Workscore crowding variable, and occupancy rate) and each of the six outcome variables.

RESULTS
The EDWIN score was significantly associated with decreased teaching time, specifically in indirect patient care teaching time (p=0.02). The EDWIN score also correlated with the attending spending more time with direct and indirect non-teaching patient care duties (p=0.02 and 0.03, respectively). The number of years of experience as an attending physician was also a significant predictor for more direct patient care teaching (p=0.04) and less attending-alone time (p=0.001).

CONCLUSIONS
This is the first observational time-motion study to demonstrate that crowding may detrimentally impact teaching in the Emergency Department, using the EDWIN score. Crowding, as measured by the Workscore and occupancy rate, however, did not correlate with decreased teaching time.
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