Effects of opening a vertical care area on emergency medicine resident clinical experience

Alina Tsyrulnik; Craig Rothenberg; Wendy W Sun; Arjun Venkatesh; Ryan F Coughlin; Katja Goldflam; Rohit B Sangal

doi:10.1002/aet2.11040

Effects of opening a vertical care area on emergency medicine resident clinical experience

AEM Educ Train. 2024 Nov 20;8(6):e11040. doi: 10.1002/aet2.11040. eCollection 2024 Dec.

Authors

Alina Tsyrulnik¹, Craig Rothenberg¹, Wendy W Sun¹, Arjun Venkatesh¹, Ryan F Coughlin¹, Katja Goldflam¹, Rohit B Sangal¹

Affiliation

¹ Yale University School of Medicine New Haven Connecticut USA.

PMID: 39574943
PMCID: PMC11576914 (available on 2025-11-20)
DOI: 10.1002/aet2.11040

Abstract

Background: Challenging clinical environments faced by emergency departments (EDs) have led to operational changes including implementation of vertical care units and fast-track units. Little is known regarding the impact of such units on resident physician clinical education.

Methods: A retrospective, observational study was performed at an urban quaternary care ED evaluating the effect of opening a vertical care unit with a triage physician directing lower acuity patients to be seen by physician associates (PAs)/advanced practice registered nurses (APRNs) on the following parameters: (1) percentage of patients seen by residents, (2) Emergency Severity Index (ESI) of patients seen by residents, (3) number of procedures performed by residents, (4) number of patients per shift seen by residents, (5) percentage of critical care patients seen by residents, and (6) percentage of behavioral health patients seen by residents.

Results: Comparing the implementation of the vertical care unit to the prior 3 months, postgraduate year (PGY)-1 residents had greater exposure to ESI Levels 1 and 2 (odds ratio [OR] 2.15) and more critical care (OR 2.58). PGY-2 and PGY-3 residents had a lower exposure to ESI 1 and 2 patients (PGY-2 OR 0.63, PGY-3 OR 0.61) and less critical care exposure (OR 0.64 for PGY-2 and OR 0.62 for PGY-3) after implementation. PGY-1 residents saw fewer behavioral health patients (OR 0.65) while the other two classes saw more (PGY-2 OR 1.64, PGY-3 OR 2.74). ESI 4 and 5 exposure decreased for all classes (PGY-1 OR 0.15, PGY-2 OR 0.86, PGY-3 OR 0.72). No significant difference was found in the proportion of patients treated by residents (p = 0.85) or the number of procedures performed by residents (p = 0.25) comparing the implementation of a vertical care unit to the prior 3 months.

Conclusions: This study suggests no detrimental effects of vertical care unit implementation on multiple resident education outcomes including the number and acuity level of patients seen as well as procedure numbers of resident trainees. While the outcomes measured did not show significant negative effect for the resident compliment as a whole, we noted changes to the distribution of patient acuity based on PGY level. Similar assessments are recommended to determine the educational impact of comparable operational changes in other EDs.