Purpose

Learners, either medical students or residents, often perform the initial assessment of patients visiting the emergency department (ED). It is unclear, however, if learners affect the rate of short-term unscheduled return visits. The objective of this study was to determine if the involvement of learners in ED visits increases the rate of return visits.

Methods

This was a retrospective cross-sectional analysis of ED visit data at a single tertiary care centre over a 1-year period. Return visits were defined as those presenting within 72 h of discharge from an initial non-admit ED visit and resulting in an admission on the second visit. A generalized linear mixed model was used to determine the odds ratios of return visits, adjusting for prespecified co-variates, with and without learners involved during the initial visit. Secondary analyses assessed for associations between learner level of training, program of study and return visits.

Results

Return visits occurred after 658 (1.3%) of 51,149 encounters involving learners and 701 (0.8%) of 83,310 encounters with no learner involvement. Involvement of learners in ED initial visits was not associated with increased odds of return visits (adjusted OR 1.13 [95% CI 0.71–1.81]), although the point estimates were heterogeneous over learner level of training, with clerkship students (medical student years 3 and 4) and senior residents (post-graduate years 4 and 5) trending towards reduced odds of a return visit. Resident program of study did not independently predict return visits.

Conclusions

This study demonstrated that the involvement of learners in ED patient assessments is not associated with increased odds of short-term unscheduled return visits.

中文翻译：

---

学习者参与急诊科患者评估对需要住院的短期回访的影响：一项横断面研究

目的

学习者，无论是医学生还是住院医师，经常对急诊科 (ED) 的患者进行初步评估。然而，尚不清楚学习者是否会影响短期计划外回访的比率。本研究的目的是确定学习者参与 ED 就诊是否会增加回访率。

方法

这是对单一三级护理中心 1 年内 ED 就诊数据的回顾性横断面分析。回访被定义为在首次非入院 ED 就诊后 72 小时内出现并导致第二次就诊的患者。使用广义线性混合模型来确定回访的优势比，调整预先指定的协变量，在初次访问期间有和没有学习者参与。二次分析评估了学习者培训水平、学习计划和回访之间的关联。

结果

回访发生在 51,149 次涉及学习者的接触中的 658 次（1.3%）和 83,310 次没有学习者参与的接触中的 701 次（0.8%）之后。学习者参与 ED 初次就诊与回访几率增加无关（调整后的 OR 1.13 [95% CI 0.71-1.81]），尽管点估计值在学习者培训水平上存在异质性，见习生（医学生 3 年） 4) 和高级居民（研究生 4 年和 5 年）趋向于减少回访的几率。居民学习计划并不能独立预测回访。

结论

这项研究表明，学习者参与 ED 患者评估与短期不定期回访的几率增加无关。