Poster 27

Feb 19, 2017 by AAPOS editor in  Poster Session 2

 Impact of Medical Trainees on Clinical Efficiency in a Pediatric Ophthalmology Practice

Leah G. Reznick; Michelle R. Hribar; Sarah Read-Brown; Issac Goldstein; Michael F. Chiang; Thomas R. Yackel

Oregon Health Sciences University — Casey Eye Institute
Portland, OR

Introduction:  In an academic clinical practice, little information exists to describe how medical trainees affect the flow of an ophthalmology practice.  Using data obtained through electronic health records (EHR) analysis, we can understand how training physicians influences the examination and wait times for patients.

Methods:  Clinical work-flow was mapped through time-stamp data obtained through the EHR. EHR analysis identified the appointment, examination, and wait times via activity by staff, medical trainees, and the pediatric ophthalmologist within the patient chart.1

Results:  EHR time stamps were evaluated for one pediatric ophthalmologist (LR) during each half-day session. 8013 patient encounters were identified: 853 with a trainee and 7160 without.  The mean exam time with a trainee was 27% longer (37 mins with and 25 mins without a trainee, p<0.001).  Mean wait time was 26% longer for clinic sessions with a trainee (40 mins with and 32 mins without trainees, p<0.001).  Mean clinic length increased by 5.0% for a half-day session (237 mins with and 226 mins without a trainee, p-value = 0.001)

Discussion:  Future studies are needed to investigate why medical trainees worsen wait times and clinical session lengths for all patients.  Residents increase exam and wait times the most followed by fellows and students.  Further analysis can help create schedules that maximize clinical efficiency with trainee involvement.

Conclusion:  Inclusion of medical trainees within a single pediatric ophthalmology practice lengthens appointment times and worsens wait times for both the patients seen by a trainee and those who do not see a trainee.


1. Hribar MR, Read-Brown S, Reznick L, Lombardi L, Parikh M, Yackel TR, Chiang MF.  Secondary Use of EHR Timestamp data: Validation and Application for Workflow Optimization.  AMIA Proc Annu Symp. 2015.

2. Chiang, MF, Read-Brown S, Tu DC, Choi D, Sanders DS, Hwang TS, Bailey S, Karr DJ, Cottle E, Morrison JC, Wilson DJ, Yackel TR.  Evaluation of electronic health record implementation in ophthalmology at an academic medical center (an American Ophthalmological Society thesis).  Trans Am Ophthalmol Soc. 2013 Sep; 111:70-92.

3. Redd TK, Read-Brown S, Choi D, Yackel TR, Tu DC, Chiang MF.  Electronic health record impact on productivity and efficiency in an academic pediatric ophthalmology practice.  J AAPOS.  2014 Dec; 18(6): 584-9. doi: 10.1016/j.jaapos.2014.08.002. Epub 2014 Nov 14.

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