Increasing Off-Service Resident Productivity while on their Emergency Department Rotation Using Shift Cards

BackgroundDifferences in productivity between off-service residents rotating in the emergency department (ED) and their emergency medicine (EM) resident counterparts have never been directly quantified.ObjectivesWe sought to quantify the difference between off-service residents rotating in the ED and their EM resident counterparts. We also sought to find whether shift cards could be used to increase the productivity of off-service residents rotating in the ED.MethodsThis is a prospective cohort study conducted at an urban, tertiary, Level I trauma center. We implemented the use of shift cards for off-service residents during their EM rotation. Completion of the shift card involved recording patients seen and their dispositions, procedures done, and documenting a learned bedside teaching point from their shift that day. Productivity was measured in terms of patients seen per hour (PPH) and relative value units per hour (RVU/h).ResultsOff-service residents showed a productivity of 0.529 PPH (95% confidence interval [CI] 0.493–0.566) and 1.40 RVU/h (95% CI 1.28–1.53) prior to implementation of shift cards. With the introduction of shift cards, productivity increased to 0.623 PPH (95% CI 0.584–0.663, p = 0.001) and 1.77 RVU/h (95% CI 1.64–1.91, p = 0.001). In comparison, first year EM resident productivity was 0.970 PPH (95% CI 0.918–1.02) and 3.01 RVU/h (95% CI 2.83–3.19).ConclusionsShift cards can be used to foster motivation for off-service residents rotating in the ED, and is a simple and cost-effective method to improve system-based practices and utilization of resources.