Impact of adding a medical intern to the emergency department night shift.

Abstract

To evaluate whether adding a fourth physician to the emergency department night shift would improve metrics. This retrospective cohort study used data from the Meir Medical Centre emergency department, 1 January 2021 to 31 May 2023. The study period included adding a fourth physician to the night shift staff in September 2021. Primary and secondary outcomes were time from patient entrance to doctor's examination, time to decision about hospitalisation or discharge and rates of hospitalisation, 1 day hospitalisation and returning patients. Secondary analysis examined the mean and lowest seniority of the staff, and the mean number of patients examined by a physician during night shifts. After increasing staff, hospitalisation rates decreased minimally from 44% to 42% (p=0.03), whereas 1 day hospitalisation rates increased from 26% to 28% (p=0.006). Paradoxically, time to disposition increased slightly from 4.5 to 4.7 hours (p<0.001). No significant changes were noted in return visit rates or time to first physician encounter. The study did not result in significant impacts on key performance indicators after adding a physician to night shift staffing. Our findings suggest that increasing physician numbers did not significantly improve overall emergency department efficiency. The only benefit observed was a decrease in the number of patients per physician, potentially alleviating individual physician workload. Adding a physician to the emergency department night shift staff did not result in significant improvements in work efficiency, as measured by the parameters assessed in this study.