The Effect of Signed-Out Emergency Department Patients on Resident Productivity

Citations of this article
Mendeley users who have this article in their library.


Background: Transitions of care and patient hand-offs between physicians have important implications for patient care. However, what effect caring for signed-out patients has on providing care to new patients and education is unclear. Objective: We sought to determine whether the number of patients a physician receives in sign-out affects productivity. Methods: This was a retrospective cohort study, conducted at an emergency medicine residency program. A general estimation equation was constructed to model productivity, defined as new patients evaluated and relative value units (RVUs) generated per shift, relative to the number of sign-outs received, and training year. A secondary analysis evaluated the effect of signed-out patients in observation. Results: We evaluated 19,389 shifts from July 1, 2010 to July 1, 2017. Postgraduate year (PGY)-1 residents without sign-out evaluated 10.3 patients (95% confidence interval [CI] 9.83 to 10.7), generating 31.6 RVUs (95% CI 30.5 to 32.7). Each signed-out patient was associated with −0.07 new patients (95% CI −0.12 to −0.01), but no statistically significant decrease in RVUs (95% CI −0.07 to 0.28). PGY-2 residents without sign-out evaluated 13.6 patients (95% CI 12.6 to 14.6), generating 47.7 RVUs (95% CI 45.1 to 50.3). Each signed-out patient was associated with −0.25 (95% CI −0.40 to −0.10) new patients, and −0.89 (95% CI −1.22 to −0.55) RVUs. For all residents, observation patients were associated with more substantial decreases in new patients (−0.40; 95% CI −0.47 to −0.33) and RVUs (−1.11; 95% CI −1.40 to −0.82). Conclusions: Overall, sign-out burden is associated with a small decrease in resident productivity, except for observation patients. Program faculty should critically examine how signed-out patients are distributed to address residents’ educational needs, throughput, and patient safety.




Joseph, J. W., Stenson, B. A., Dubosh, N. M., Wong, M. L., Chiu, D. T., Fisher, J., … Sanchez, L. D. (2018). The Effect of Signed-Out Emergency Department Patients on Resident Productivity. Journal of Emergency Medicine, 55(2), 244–251.

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free