• Ellen J Weber.
• Dr. Weber is professor of emergency medicine, Department of Emergency Medicine, University of California, San Francisco, San Francisco, California.
• Acad Med. 2015 Jan 1; 90 (1): 14-5.

AbstractIn this issue of Academic Medicine, Webster and colleagues explore the impact of a government-imposed mandate in Ontario, Canada, to limit the length of time patients can stay in the emergency department. The rule is aimed at emergency department crowding, which has been shown to result in poorer-quality care, longer hospital stays, and higher mortality. Webster and colleagues found that learners were concerned about the effect of a time target on both their education and on patient-centered care, and sensed a "hidden curriculum" refocusing teaching on "efficiency rather than safe, compassionate care."The introduction of time targets in emergency departments may seem like a threat to both the education of learners and the quality of patient care. However, one aspect of quality is patient-centered care, which requires sensitivity to patients' need for information, physical comfort, and reassurance. In this Commentary, the author describes the patient experience in the typical teaching hospital emergency department, arguing that for too long, teaching institutions have given only lip service to patient-centered care in favor of traditional teaching models. It is time to rebalance the scales so that the patient's experience is a central feature of the curriculum, and putting a time limit on how long patients stay in the emergency department may be one way to do it.

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