Introduction The job of an EM consultant involves multitasking and dealing with multiple unscheduled interactions (UI). The fluid, unpredictable, time pressurised and multi-professional nature of EM makes it particularly susceptible to UI. An increasing number of UI can result in increased error. An Increasing number of decisions, irrespective of complexity can lead to error and decision fatigue. We aim to map the number of UI an EM consultant faces when on shift.

Objectives This study attempted to answer the following questions

1. In a day how many unscheduled interactions does the senior EM physician deal with?

2. How many of these are interactions are clinical interactions?

3. What is the average length of time spent dealing with these unscheduled interactions?

Methods This prospective observational study took place at a single centre urban ED in the West Midlands. The study period was from 1.12.15 to 23.12.15. An EM consultant was shadowed on shift by a medical student who recorded all non-patient interactions involving the consultant. The consultant had no input into data collection. The nature of the UI,, the time spent; and the outcome were recorded on a data collection form. This was then collated and analysed.

Results A total of 23 shifts over 135 hours 34 minutes were observed.There was a mix of early (0800–1600), late (1600–2100) and weekend shifts.

▸ All 10 members of the consultant body were observed.

▸ Total Number of UI in study period: 2082

▸ Average Number of UI per hour: 17.95 UI/hour.

▸ UI rate (time per UI): 3 minutes 22 seconds

▸ Average time per UI: 87.5 seconds (Range 10 seconds–34 minutes).

▸ Clinical vs Non Clinical Interactions: 94% vs 6%.

Conclusion In this single centre study of an urban UK emergency department, 40% of shop floor consultant time is spent dealing with UI. The majority (94%) of these UI related to clinical interactions. In this study this equates to 17.95 UI per hour with an average time spent dealing with each interaction of 87.5 seconds

Discussion Modern EM relise on a senior EM physician, running an organised shift, to cope with the vast number of UI that must be resolved. Combining the intensity of this role with an individual patient load is not feasible and departments should consider the initiation of a ‘captain of the ship,’ or ‘Fat Controller’ role along with a second senior EM physician to provide individual consultant level care to the sickest individuals who require senior input.