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Isaac Goldstein, Michelle Hribar, Sarah Read-Brown, Michael F Chiang; Quantifying the Impact of Trainees on Outpatient Ophthalmology Clinic Workflow. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5060. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
While the presence of trainees is ubiquitous in academic outpatient clinics, their effect on clinic workflow has been largely unexamined. This study quantifies the impact of trainees on ophthalmology outpatient appointment times.
We analyzed the 2014 outpatient appointments (N=49,644) of 33 ophthalmologists from 12 subspecialties who used either residents or fellows at a large academic medical center (Casey Eye Institute, OHSU). Times were derived from the electronic health record using methods that we have previously published. We used a linear mixed effects model to analyze the relationship between appointment time and use of trainees, with the trainee type and the patient billing level as fixed effects and the providers and patients as random effects.
As seen in Figure 1, all trainees lengthened appointment times compared to appointments with no trainees: residents lengthened times by 13.9 ± 0.7 minutes, fellows by 12.0 ± 0.64 minutes, and both in one appointment lengthened times by 25.4 ± 1.4 minutes (p<2.2e-16). When analyzed separately, providers’ use of trainees had different effects on appointment lengths. Of the 33 providers who used residents, 22 saw a statistically-significant lengthening of appointment time when using residents, 1 saw a decrease. Of the 31 providers who used fellows, 18 saw a statistically-significant lengthening of appointment time when using fellows, 4 saw a decrease. Of the 28 providers who used both types of trainees in appointments, 18 saw a statistically-significant lengthening of appointment time, 1 saw a decrease. During clinic sessions in which trainees were used, appointments without trainees were lengthened by 2.1 ± 0.5 minutes (p<2.2e-16). 14 providers saw a lengthening of mean appointment time for such appointments, and 9 saw a decrease.
In general, appointments that use trainees are significantly longer than appointments without trainees. Trainees affect the lengths of all appointments during a clinic session, even those that do not directly involve a trainee. The effects of trainees varies among providers, which suggests there may be ways to use trainees more efficiently and merits further investigation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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