Transparency in Admissions and Personalized Learning Through Resident Patient Selection

Andrea Archibald; Paul Zimmerman; Winn Seay; Lalit Verma; Jonathan Wilson; Poonam Sharma

doi:10.31486/toj.21.0066

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Figure 1.
Resident presurvey.
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Figure 2.
Resident postsurvey. DRH, Duke Regional Hospital.
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Figure 3.
Hospitalist survey. DRH, Duke Regional Hospital; ER, emergency room.

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Table 1.

Postsurvey Resident Responses to Yes/No Questions

Survey Question	Total Responses	Proportion of Yes Responses	95% CI^a
Did participation in the new triage workflow allow you to see more of the cases you described in the presurvey or cases of similar educational value?	16	0.9375	0.6977, 0.9984
Were you able to direct cases to your team that you knew were of interest to your team (ie, meets the learning goals of the intern or student)?	17	1.000	0.8049, 1.000
Do you think the new triage process should be continued?	17	1.000	0.8049, 1.000

↵^aBecause of the small sample size, the 95% CIs for the proportions were created using exact binomial limits (Clopper-Pearson).

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Table 2.

Postsurvey Representative Resident Comments

“Increased resident autonomy. Allows better timing of resident team admissions to optimize education.”

“Improves camaraderie and culture between residents and hospitalists.”

“I love it! It helps to manage workflow of your team which adds to the organizational skills as a [senior resident]. It also allowed me to ask my intern, “Have you seen x, y, z before?” and take patients of interest to them.”

“Cases that were great learning cases and ones that provided great discussion were shunted over to the teams. This made rounds more interesting and fun. It also allowed for variety and diversity of cases.”

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Table 3.

Hospital Metrics in Prior Year Compared to Resident Triage Study Period

		1-Year Prior Period^a		Resident Triage Study Period^b
Group	Measure	n	Mean (SD)	n	Mean (SD)	Estimate (Equivalency Interval)^c
Teaching group	Length of stay	672	6.03 (17.04)	660	4.88 (6.90)	1.15 (–0.02, infinity)
	Length of stay, outlier removed^d	671	5.44 (7.36)	660	4.88 (6.90)	0.56 (–0.09, infinity)
	Case mix index	673	1.39 (0.80)	660	1.39 (0.77)	0 (–0.07, 0.07)
Nonteaching group	Length of stay	1,998	5.38 (6.64)	2,590	4.90 (4.79)	0.48 (0.20, infinity)
	Case mix index	1,999	1.45 (0.95)	2,590	1.42 (0.93)	0.03 (–0.01, 0.08)

↵^aThe 1-year prior period is August 1 to December 31, 2017.
↵^bThe resident triage study period is August 1 to December 31, 2018.
↵^cDifference of prior year period minus resident triage study period.
↵^dLength of stay >1 year.
Note: n=number of patients.

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Table 4.

Top 10 Discharge Diagnoses on the Teaching Service by Time Period

1-Year Prior Period^a	Resident Triage Study Period^b
1. Sepsis, unspecified organism	1. Sepsis, unspecified organism
2. Hypertensive heart and chronic kidney disease with heart failure and stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease	2. Hypertensive heart and chronic kidney disease with heart failure and stage 1 through 4 chronic kidney disease, or unspecified chronic kidney disease
3. Chronic obstructive pulmonary disease with (acute) exacerbation	3. Chronic obstructive pulmonary disease with (acute) exacerbation
4. Hypertensive heart disease with heart failure	4. Acute kidney failure, unspecified
5. Acute kidney failure, unspecified	5. Hypertensive heart disease with heart failure
6. Urinary tract infection, site not specified	6. Pneumonia, unspecified organism
7. Non-ST elevation myocardial infarction	7. Other acute pulmonary embolism without acute cor pulmonale
8. Pneumonia, unspecified organism	8. Type 1 diabetes with ketoacidosis without coma
9. Pneumonitis due to inhalation of food and vomit	9. Non-ST elevation myocardial infarction
10. Acute and chronic respiratory failure with hypoxia	10. Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease