Article Text
Abstract
Objectives Emergency physician productivity, often defined as new patients evaluated per hour, is essential to planning clinical operations. Prior research in this area considered this a static quantity; however, our group’s study of resident physicians demonstrated significant decreases in hourly productivity throughout shifts. We now examine attending physicians’ productivity to determine if it is also dynamic.
Methods This is a retrospective cohort study, conducted from 2014 to 2016 across three community hospitals in the north-eastern USA, with different schedules and coverage. Timestamps of all patient encounters were automatically logged by the sites’ electronic health record. Generalised estimating equations were constructed to predict productivity in terms of new patients per shift hour.
Results 207 169 patients were seen by 64 physicians over 2 years, comprising 9822 physician shifts. Physicians saw an average of 15.0 (SD 4.7), 20.9 (SD 6.4) and 13.2 (SD 3.8) patients per shift at the three sites, with 2.97 (SD 0.22), 2.95 (SD 0.24) and 2.17 (SD 0.09) in the first hour. Across all sites, physicians saw significantly fewer new patients after the first hour, with more gradual decreases subsequently. Additional patient arrivals were associated with greater productivity; however, this attenuates substantially late in the shift. The presence of other physicians was also associated with slightly decreased productivity.
Conclusions Physician productivity over a single shift follows a predictable pattern that decreases significantly on an hourly basis, even if there are new patients to be seen. Estimating productivity as a simple average substantially underestimates physicians’ capacity early in a shift and overestimates it later. This pattern of productivity should be factored into hospitals’ staffing plans, with shifts aligned to start with the greatest volumes of patient arrivals.
- emergency department operations
- care systems
- crowding
- operational
- staff support
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Footnotes
Contributors JWJ, SD and LDS conceived of the study. SD and OL performed initial data gathering and aggregation. JWJ performed the initial data analysis and modelling, EHW performed further analysis and model verification. JWJ drafted the manuscript, and all authors contributed substantially to its revision. JWJ takes responsibility for the paper as a whole.
Funding This study was funded by Harvard Medical School (10.13039/100006691). Additional support was provided by the Eleanor and Miles Shore 50th Anniversary Fellowship Program for Scholars in Medicine at Harvard Medical School.
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centres, or the National Institutes of Health.
Competing interests SD and OL are employees of LogixHealth, which provides billing, coding and analytics services for EDs throughout the USA.
Patient consent Not required.
Ethics approval The study was granted an exemption to examine operational and productivity metrics by the institutional review board of the academic hospital (Beth Israel Deaconess Medical Center IRB) affiliated with two of the sites (none of the hospital sites have their own institutional review board).
Provenance and peer review Not commissioned; externally peer reviewed.