Reducing length of stay and satisfying learner needs.

ABSTRACT

A complicated relationship exists between emergency department (ED) learner needs and patient flow with solutions to one issue often negatively affecting the other. Teaching shifts that allow clinical teachers and learners to interact without the pressure of patient care may offer a mutually beneficial solution. This study investigated the relationship between teaching shifts on ED length of stay, student self-efficacy and knowledge application.In 2012-2013, a prospective, cohort study was undertaken in a large Canadian acute-care teaching centre. All 132 clinical clerks completing their mandatory two-week emergency medicine rotation participated in three teaching shifts supervised by one faculty member without patient care responsibilities. The curriculum emphasized advanced clinical skills and included low fidelity simulation exercises, a suturing lab, image interpretation modules and discussion about psychosocial issues in emergency medicine. The clerks then completed seven clinical shifts in the traditional manner caring for patients under the supervision of an ED attending physician. Length of stay was compared during and one week following teaching shifts. A self-efficacy questionnaire was validated through exploratory factor analysis. Pre/post knowledge application was assessed using a paper-based clinical case activity.Across 40.998 patient visits, median length of stay was shortened overall by 5 minutes (95 % CI1.2, 8.8) when clerks were involved in their teaching shifts. In the first academic block, median length of stay was reduced by 20 minutes per patient (95 % CI12.7, 27.3). Self-efficacy showed significant improvement post teaching shifts (p < 0.001) with large effect sizes (d > 1.25) on dimensions of knowledge base, suturing, trauma and team efficacy. Students' knowledge application scores improved from pre to post (p < 0.01), with notable gains in the generation of differential diagnoses.Teaching shifts are an effective educational intervention that has a positive relation to ED patient flow while successfully attending to learner needs. Teaching shifts for the most naïve clerks in the first academic block appear to maximally benefit length of stay. Students demonstrated improved self-efficacy and knowledge application after their teaching shifts.