How Do Physicians and Nurses Spend Their Time in the Emergency Department?☆,☆☆,★,★★
Introduction
The goals of health care managers, policy makers, and workers include improving efficiency and productivity, reducing waste, redistributing resources, and decreasing costs. Van de Leuv wrote, “The ultimate goal of the emergency department director, or anyone on the staff of the emergency department for that matter, should be to attain maximum efficiency.”1 Hendrickson and Kovner emphasized that “in an era of nurse shortage, it is important to maximize the time nurses spend on patient care and minimize the time spent on tasks that do not require professional nursing expertise.”2
Achieving these goals depends in part on understanding the type of tasks health care workers perform and the amount of time they spend accomplishing them. For example, in one study it was found that “some 31% of the average healthcare worker's time was wasted through paperwork, rework, duplicate work or inappropriate work.”3 How health care workers spend their working time is of interest not only to managers and policymakers but to health services researchers. Finkler et al4 noted that studies requiring such information range from evaluations of the use of physical therapy personnel time, through work measurements for nursing services, to Hsiao's work on development of a relative-value scale for physician services.
Mamlin and Baker wrote, “In spite of the growing interest in health planning and new health care delivery systems, very little refinement of measurement technique has been published describing methodologies for measuring such fundamental parameters of clinic operation as patient temporal movement and physician activity.”5 Almost a quarter century later, the same could be said of emergency medicine, a field in which few work measurement or task analysis studies have been conducted to better define the work environment.
We conducted a time-and-motion study to determine how emergency physicians and nurses spend their time in the ED. The number and types of activities performed by subjects and the time spent on these activities were evaluated, and the distances walked by subjects while on clinical duty was measured.
Section snippets
Materials and Methods
The study was conducted from June 14 to July 23, 1993, in a 36-bed ED with an annual census of 84,000 in a central city teaching hospital. The hospital sponsors an emergency medicine residency program (postgraduate years 1 through 3). At the time of the study, faculty physicians worked 8-hour shifts, resident physicians 9-hour shifts, and emergency nurses 11- or 12-hour shifts. For 15 hours of the day, the sole job of one faculty physician (the staffing faculty physician) was to oversee patient
Results
Thirty-nine ED care providers were observed: 10 faculty physicians, 12 resident physicians, and 17 emergency nurses. All of the faculty physicians were men; their mean age was 42.7±7.1 years, and their mean full-time ED experience was 15.6±6.3 years. Of the resident physicians observed, 11 were men, and 1 was a woman; their mean age was 28.3±1.5 years. Eight were second-year residents and four were third-year residents. Of the emergency nurses, 16 were women and 1 was a man; their mean age was
Discussion
Our time-and-motion study demonstrated that emergency physicians and nurses spent almost half of their time on indirect patient care activities. Physicians spent more time on indirect patient care activities than nurses. Whether this difference resulted primarily from the difference in charting time or from other factors is unknown. Emergency nurses spent more time on personal activities than did physicians. One possible explanation for this findings is that nurses in our ED work 12-hour shifts
Acknowledgements
We thank the emergency physicians and nurses at the Emergency Medicine and Trauma Center, Methodist Hospital of Indiana, for participating in this study; and Bruce D Janiak, MD, and Debra Mauk of The Toledo Hospital for sharing the methodology and results of their unpublished ED time-and-motion study.
References (9)
- et al.
An analysis of emergency department time: laying the groundwork for efficiency standards
QRB Qual Rev Bull
(1987) Time study of patient movement through the emergency department: Sources of delay in relation to patient acuity
Ann Emerg Med
(1987)- et al.
A time and motion study of the anaesthetist’s intraoperative time
Br J Anaesth
(1988) Efficiency in the emergency department
Cited by (111)
What is nursing work? A meta-narrative review and integrated framework
2021, International Journal of Nursing StudiesCitation Excerpt :Potter et al. (2005) found that nurses spend 26% of their time in consultation with other people (nurses, other colleagues, patients, and families), and 23% of their time documenting care. Researchers consistently report that nurses spend more time on arranging and documenting care than interacting with patients (Hendrich et al., 2008, Hendrickson et al., 1990, Hollingsworth et al., 1998, Westbrook et al., 2011). For example, Westbrook et al. (2011) reported that nurses spend 37% of their time with patients, with the reminder of their time being used for professional communication, indirect care, and medication preparation.
Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network
2018, American Journal of MedicineInterface design dividing physical findings into medical and trauma findings facilitates clinical document entry in the emergency department: A prospective observational study
2018, International Journal of Medical InformaticsCitation Excerpt :Recently, ED care has become increasingly complex with the growing demands for multidisciplinary care, high efficiency, high quality, and timely patient treatment; however, malpractice claims are also becoming more common [5], indicating the need for high-quality EMRs in the ED. As a result, EMRs now take up a large proportion of the physicians’ working time [6–9]. Thus, it is critically important to satisfy the need for high-quality efficient EMRs that can be completed by ED physicians simultaneously while performing a number of clinical examinations.
Surgery Resident Time Consumed by the Electronic Health Record
2020, Journal of Surgical Education
- ☆
From the Summer Research Program,* the Emergency Medicine and Trauma Center,‡ and the Department of Medical Research,§ Methodist Hospital of Indiana, Indianapolis, and Wabash College, Crawfordsville,∥ IN.
- ☆☆
Supported by a grant from Hill-Rom Company, Batesville, IN.
- ★
Reprint no. 47/1/82924
- ★★
Address for reprints: Journal Reprint Requests, Emergency Medicine and Trauma Center, Methodist Hospital of Indiana, 1701 North Senate Boulevard, Indianapolis, IN 46202, 317-929-3525, [email protected]