Annals of Emergency Medicine
Volume 50, Issue 4 , Pages 419-423 , October 2007

Shifting Toward Balance: Measuring the Distribution of Workload Among Emergency Physician Teams

  • Scott Levin, MS

      Affiliations

    • Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, TN
    • Department of Anesthesiology and Center for Perioperative Research in Quality, Vanderbilt University Medical Center, Nashville, TN
    • Corresponding Author InformationAddress 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
    • ,
  • Dominik Aronsky, MD, PhD

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
    • Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.
    • ,
  • Robin Hemphill, MD, MPH

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
    • ,
  • Jin Han, MD

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
    • ,
  • Jason Slagle, PhD

      Affiliations

    • Department of Anesthesiology and Center for Perioperative Research in Quality, Vanderbilt University Medical Center, Nashville, TN
    • ,
  • Daniel J. France, PhD, MPH

      Affiliations

    • Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, TN
    • Department of Anesthesiology and Center for Perioperative Research in Quality, Vanderbilt University Medical Center, Nashville, TN
    • Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN

Received 7 June 2006 ,Revised 14 March 2007 ,Accepted 6 April 2007.

References 

  1. Cowan RM, Trzeciak S. Clinical review: emergency department overcrowding and the potential impact on the critically ill. Crit Care. 2005;9:291–295
  2. Derlet RW, Richards JR. Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med. 2000;35:63–68
  3. Derlet RW. Overcrowding in emergency departments: increased demand and decreased capacity. Ann Emerg Med. 2002;39:430–432
  4. Magid DJ, Asplin BR, Wears RL. The quality gap: searching for the consequences of emergency department crowding. Ann Emerg Med. 2004;44:586–588
  5. Schull MJ, Vermeulen M, Slaughter G, et al. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Ann Emerg Med. 2004;44:577–585
  6. Sprivulis PC, Da Silva JA, Jacobs IG, et al. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust. 2006;184:208–212
  7. Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20:402–405
  8. US General Accounting Office. Hospital Emergency Departments: Crowded Conditions Vary Among Hospitals and Communities. Washington, DC: US General Accounting Office; 2003;Report No. GAO-03-460
  9. France DJ, Levin S, Hemphill R, et al. Emergency physicians’ behaviors and workload in the presence of an electronic whiteboard. Int J Med Inform. 2005;74:827–837
  10. Levin S, France DJ, Hemphill R, et al. Tracking workload in the emergency department. Hum Factors. 2006;48:526–539
  11. Moray N. Mental Workload: Its Theory and Measurement. New York, NY: Plenum Press; 1979;
  12. O’Donnel D, Eggemeir T. Workload assessment methodology. In:  Wear RL editors. Handbook of Perception and Human Performance: Volume2 (Cognitive Process and Performance). New York, NY: Wiley; 1986;p. 42.1–42.49
  13. Aiken LH, Clarke SP, Sloane DM, et al. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288:1987–1993
  14. Keller KL, Koenig WJ. Sources of stress and satisfaction in emergency practice. J Emerg Med. 1989;7:293–299
  15. Schwartz LR, Overton DT. Emergency department complaints: a one-year analysis. Ann Emerg Med. 1987;16:857–861
  16. France DJ, Levin S. System complexity as a measure of safe capacity for the emergency department. Acad Emerg Med. 2006;13:1212–1219
  17. Biros MH, Adams JG, Wears RL. Errors in emergency medicine: a call to action. Acad Emerg Med. 2000;7:1173–1174
  18. Chisholm CD, Collison EK, Nelson DR, et al. Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and “multitasking”?. Acad Emerg Med. 2000;7:1239–1243
  19. Coiera EW, Jayasuriya RA, Hardy J, et al. Communication loads on clinical staff in the emergency department. Med J Aust. 2002;176:415–418
  20. Parker J, Coiera E. Improving clinical communication: a view from psychology. J Am Med Inform Assoc. 2000;7:453–461
  21. Fordyce J, Blank FS, Pekow P, et al. Errors in a busy emergency department. Ann Emerg Med. 2003;42:324–333

 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.

 Available online June 7, 2007.

 Reprints not available from the authors.

PII: S0196-0644(07)00452-0

doi: 10.1016/j.annemergmed.2007.04.007

Annals of Emergency Medicine
Volume 50, Issue 4 , Pages 419-423 , October 2007

Article Tools

* Image Usage & Resolution