Abstract Manager

Oral

OG2-1-2

Accept

I declare I have no actual or potential conflict of interest in relation to this program.

no

General Call (Workshop, Oral Presentation, Poster Presentation)

Oral

Education Research

Jr. Faculty (less than 5 years in practice)

yes

The impact of learner involvement in emergency department patient assessments on short-term return visits: A cross-sectional study

Learners, either medical students or residents, often perform the initial assessment of patients visiting the Emergency Department (ED). Their involvement in the ED has been shown to increase patients' length of stay, physicians' time to disposition decision, departments' utilization of imaging and admission rates. It is unclear, however, if learners affect the rate of short-term unscheduled return visits. The objective of this study was to determine if the involvement of learners in ED visits increases the rate of short-term unscheduled return visits.

This study was a retrospective cross-sectional analysis of ED visit data at a single tertiary care center over a one-year period. Return visits were defined as ED visits presenting within 72 hours of discharge from an initial non-admit ED visit and resulting in an admission on the second visit. The primary outcome was the odds of return visits with and without learners involved during the initial visit. The secondary outcome assessed the interaction of level of training and program on return visits.

Return visits meeting our criteria occurred after 658 (1.3%) of 51,149 encounters involving learners and 701 (0.8%) of 83,310 encounters with no learner involvement (adjusted OR = 1.15, [95% CI 1.03 to 1 .29]). This effect was heterogeneous over learner level of training with no association between clerkship students or senior residents and return visits. However, involvement of post-graduate year (PGY) one (adjusted OR = 1.28, [95% CI 1.09 to 1.50]), PGY2 (adjusted OR = 1.24, [95% CI 1.00 to 1.53 ]) and PGY3 (adjusted OR = 1.45, [95% CI 1.18 to 1.79]) residents significantly increased the odds of a return visit. Program of study did not independently predict return visits.

This study demonstrated that the involvement of learners, specifically PGY1, PGY2 and PGY3 residents, in ED patient assessments increased the rate of short-term unscheduled return visits. Further work is needed to understand the factors that contribute to this phenomenon.

emergency medicine

bounce-back

patient safety

General

Patient Safety

Postgraduate

Undergraduate

Yes

Yes

Yes

Yes

Yes