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What do emergency physicians in charge do? A qualitative observational study
  1. Ian Hosking1,
  2. Adrian Boyle2,
  3. Vazeer Ahmed2,
  4. John Clarkson1
  1. 1 Engineering Design Centre, Cambridge University, Cambridge, England
  2. 2 Cambridge University Hospitals Foundation Trust, Cambridge, England
  1. Correspondence to Dr Adrian Boyle, Box 87, Emergency Department, Addenbrookes Hospital, Cambridge CB2 2QQ, UK; adrian.boyle{at}


Introduction The emergency physician in charge role has developed in many large EDs to assist with patient flow. We aimed to describe and classify the problem-solving actions that this role requires.

Methods We interviewed senior emergency physicians and performed iterative, qualitative observations, using continuous reflective inquiry, in a single centre. We reviewed and classified these approaches by consensus.

Results Nine different problem-solving approaches were identified. These are deflecting, front loading, placing, plucking, flooding, targeting, chasing, guiding and juggling. These are useful for training and developing our understanding of how to manage an ED.

Conclusions Emergency physicians in charge have a number of problem-solving approaches that can be readily defined. We have described and categorised these. These results are potentially useful for developing decision support software.

  • Emergency department crowding
  • overcrowding
  • safety
  • management
  • patient flow
  • heuristics

Statistics from


  • Contributors VA and AB conceived the study. IH designed and conducted the study. All authors were involved in developing consensus. AB wrote the paper and all authors approved the final version.

  • Funding This work was funded by Cambridge University Health Partners and Cambridge University Hospitals Foundation Trust. The research was also part funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England (CLAHRC EoE) at Cambridge and Peterborough NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests AB and IH are Directors of Cambridge Clinical Management Analytics which develops decision support software to understand emergency department crowding.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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