Cherry Picking Patients: Examining the Interval Between Patient Rooming and Resident Self-assignment
” Cherry Picking Patients: Examining the Interval Between Patient Rooming and Resident Self-assignment ” Brian W. Patterson et al. Academic Emergency Medicine, 2016.
Do residents preferentially pick up patients with some chief complaints faster than others? Residents assign themselves to patients as they appear from the waiting room, but the time until a patient is picked up by a resident can vary based on a multitude of factors. This study asks the question of whether or not certain chief complaints are more quickly picked up, positing that residents may preferentially assign themselves to less diagnostically challenging cases.
A retrospective medical record review on consecutive patients at a single, academic, university-based emergency department in Ohio over the course of a year looking at length of time until resident pick up of a patient and recording chief complaint, along with demographic information for those patients, using a proportional hazards model to control for pre-specified demographic and clinical confounders.
Of 30,382 eligible patients the median pickup time was 6 minutes with an interquartile range of 2-15 minutes. There was statistically significant variation in pickup times by chief complaint: ankle injury, wrist injury and allergic reaction had the shortest pickup times and abdominal problems, numbness/tingling and vaginal bleeding had the longest pickup times, although median pickup time between the longest and shortest median pickup time only varied by about five minutes
While of dubious clinical significance given the narrow range in median pickup times even between the chief complain with the most rapid and the complaint with the most sluggish pickups, this study demonstrates a statistically significant different between how quickly residents pick up patients based on chief complaint. Whether this is due to resident preference for diagnostically straightforward cases is not clear, and often quickly seeing and starting a straightforward diagnostic workup is in the best interest of flow for the department and frees residents up to pick up and think about more complex cases. Residents should always be wary of delays in treatment of sick patients, and this should be a reminder that any patient with the potential to decompensate should be immediately evaluated.