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.
Keywords: administration; batching; operations; provider assignment; throughput.
© 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.