Impact of Adding an Orthopedic Surgery Residency Program in a Rural Trauma Center

Introduction: Studies have shown that patient outcomes remain stable with the addition of residents, but the workflow of surgeons changes. Workflow encompasses many things including completing consultation requests. Recently, our level II trauma center added an orthopedic residency program to its already busy orthopedic program. This study evaluates the impact of adding this residency program on one aspect of workflow: time to complete consultations. Methods: A retrospective review of EPIC electronic health records identified patient reports within 2 time frames. The first was the control group and included patient encounters before the orthopedic residency was introduced (July 1, 2018 to June 30, 2019). The second was the study group including patient encounters after the orthopedic residency was introduced (July 1, 2021 to June 30, 2022). Results: The team reviewed 1,781 orthopedic consult orders. Median time (MT) from consult placement to note initiation significantly decreased overall (3.02 hours in the control group versus 1.09 hours in the study group, P < 0.001). For routine consults (4.73 hours versus 1.23 hours, P < 0.001), urgent consults (2.67 hours versus 1.28 hours, P = 0.019) and STAT consults (1.33 hours versus 0.88 hours, P < 0.001), individually, MT was significantly reduced. MT from consult placement to note filing overall (26.55 hours in control group versus 12.08 hours in study group, P < 0.001) and for routine consults (31.5 hours in control group versus 11.9 hours in control group, P < 0.001) decreased significantly. Urgent and STAT consults observed no significant difference between MT from consult placement to note filing ( P = 0.349 and P = 0.125, respectively). Total hospital length of stay ( P < 0.001) and length of stay after consult placement ( P = 0.003) decreased significantly between groups. Conclusions: The addition of an orthopedic residency program to a rural trauma center improved interteam communication and significantly reduced hospital length of stay, highlighting the program's value.