Impact of a residents strike on the efficiency of a teaching hospitals emergency department

Montero-Pérez FJ, Calderón De La Barca Gázquez JM, Calvo-Rodríguez R, Jiménez-Murillo LM, Tejedor-Benítez A, Roig-Rodríguez JJ

Objective: To compare health care quality indicators and cost of imaging procedures, laboratory analyses, and emergency department human resources between a period of normal staffing and a period when residents were on strike.

Methods: Cross-sectional study comparing variables during a strike and during normal staffing in a tertiary care hospital emergency department with an annual workload of 125 000 emergencies. Variables analyzed were number of emergencies attended, number of patients, triage priority levels, waiting times until first physician contact, length of stay

(LOS) in the Emergency Department, LOS in the observation unit, revisits within 72 hours, mortality in the department, hospital admission rates, number of laboratory tests ordered, and number of images ordered (conventional x-ray, ultrasound, and computed tomography).

Results: No statistically significant differences between periods were detected for care quality indicators. However, thepercentage (95% CI) of revisits within 72 hours was lower during the strike period (5.6% [4.9%-6.3%]) than in the

control period with normal staffing (6.6% [5.9%-7.3%]) (P<.05). The only significant timing difference was in the mean (95% CI) LOS in the observation area, which was shorter during the strike, at 15.2 (13.8-16.6) hours, than in the control period, at 17.7 (15.6-19.8) hours. The mean number of laboratory tests ordered during the strike was also lower, at 174 (161.5-187.6) tests vs. 202 (191.0-213.0) in the control period (P<.01). Other findings that were lower during the strike were the mean number of laboratory test parameters studied (3254 [3015-3493] parameters during the strike vs. 3883 [3671-4094]; P<.0001) and the number of relative value units (RVU) for tests (14 752 [13 509-15 995] RVUs vs. 17 442 (16 442-18 440) RVUs; P<.001). Expenditure on tests ordered was also significantly different between periods (P<.001). In addition, fewer imaging studies (mainly fewer x-rays) were ordered during the strike (P<.01). Both overall imaging costs and costs per type of imaging study were lower (P<.01). Conclusions: Emergency department care provided by emergency care physicians working together with residents was less efficient than care provided by emergency physicians working without residents in the department.

Calderón de la Barca-Gázquez JM, Calvo Rodríguez R, Jiménez-Murillo LM, Montero Pérez FJ, Roig-Rodríguez JJ, Tejedor Benítez A