Partial replacement of board-certified specialist-grade physicians with emergency medicine trainees in a busy emergency department: Lack of adverse effect on time to physician

Objectives: Standard emergency department (ED) operation goals include minimization of the time interval between patients' initial ED presentation and initial emergency physician (EP) evaluation. Following up on previous work defining factors influencing the “time to physician” (tMD) in a busy ED, the current study was undertaken to evaluate whether tMD was adversely impacted by the ED's partial replacement of specialist-grade EPs with emergency medicine (EM) trainees (at the resident and fellow level). Methods: This retrospective study was conducted for four months (September–December 2015) using an ED administrative database (EDAD) in an urban academic tertiary ED with an annual census of approximately 500,000; during the four study months, the ED census was 165,969. To minimize confounding by time of day and related factors, data analysis focused solely on the “day shift” (0600–1400) of each of the study period's 122 days. EDAD data were combined with EP rostering data to generate a multivariate linear...