Shifting Toward Balance: Measuring the Distribution of Workload Among Emergency Physician Teams
Received 7 June 2006; received in revised form 21 December 2006 and 14 March 2007; accepted 6 April 2007. published online 13 June 2007.
Refers to article:
Studying the Technical Work of Emergency Care
Christopher P. Nemeth, Richard I. Cook, Robert L. Wears
Annals of Emergency Medicine
October 2007 (Vol. 50, Issue 4, Pages 384-386) Full Text |
Full-Text PDF (68 KB)
Study objective
The objective of this investigation is to determine time-dependent workload patterns for emergency department (ED) physician teams across work shifts. A secondary aim was to demonstrate how ED demand patterns and the timing of shift changes influence the balance of workload among a physician team.
Methods
Operational measurements of an adult ED were collected from a clinical information system to characterize physician workload patterns during all current work shifts. Plots of patient load versus time were developed for each physician shift, in which patient load was defined as the number of patients a physician simultaneously managed at a point in time. Patient-load curves for each shift were superimposed during 24 hours to display how patient load was distributed among a team of physicians.
Results
Resident shift changes during daily peak occupancy periods caused patient load imbalances so that residents on a particular shift consistently managed a disproportionate number of patients (mean 9.4 patients; 95% confidence interval [CI] 6.7 to 12.1 patients) compared with other residents on duty (mean 3.4 patients; 95% CI 2.1 to 4.7 patients).
Conclusion
Physician patient load patterns and ED demand patterns should be taken into consideration when physician shift times are scheduled so that patient load may be balanced among a team. Real-time monitoring of physician patient load may reduce stress and prevent physicians from exceeding their safe capacity for workload.
aDepartment of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, TN
bDepartment of Anesthesiology and Center for Perioperative Research in Quality, Vanderbilt University Medical Center, Nashville, TN
cDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
dDepartment of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.
Address for correspondence: Scott Levin, MS, Vanderbilt University, Center for Perioperative Research in Quality, 1211 21st Ave S, Ste 732, Nashville, TN 37212-1212; 301-404-7742, fax 615-936-7373
Supervising editor: Robert L. Wears, MD, MS
Author contributions: SL and DJF conceived and designed the study. DA, RH, and JH provided advice on data analyses and interpretation. DA provided access to and answered questions about the ED information system. SL drafted the article, and DA, RH, JH, JS, and DF contributed substantially to its revision. SL takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Mr. Levin is supported by the National Science Foundation, Integrative Graduate Education and Research Traineeship Program, and an Idaho National Laboratory Graduate Fellowship. Dr. Aronsky is partially supported by NLM 1R21 LM009002-01.
ABSTRACT