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Physicians’ and nurses’ work time allocation and workflow interruptions in emergency departments: a comparative time-motion study across two countries
  1. Anna Schneider1,2,
  2. Deborah J Williams3,
  3. Colleen Kalynych3,
  4. Markus Wehler4,
  5. Matthias Weigl1
  1. 1 Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
  2. 2 Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Berlin, Germany
  3. 3 Department of Emergency Medicine, University of Florida, College of Medicine Jacksonville, Jacksonville, Florida, USA
  4. 4 Department of Emergency Medicine and Department of Medicine IV, University Hospital Augsburg, Augsburg, Germany
  1. Correspondence to Anna Schneider, Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; anna.schneider{at}


Background Globally, emergency department (ED) work is fast-paced and subject to interruptions, placing high coordination and communication demands on staff. Our study aimed to compare ED staffs’ work time allocation and interruption rates across professional roles and two national settings.

Methods We conducted a time-motion study with standardised expert observations of ED physicians and nurses in Germany and the USA. Observers coded ED staffs’ activities and workflow interruptions. General and generalised linear models were used to examine differences in activities and interruption rates between countries and ED professions.

Results 28 observations were conducted in the USA and 30 in Germany. Overall, the largest portion of time spent by ED staff in both settings was in documentation (22.0%). Physicians spent more time in verbal interaction with patients (9.9% vs 5.2% in nurses; p=0.006), in documentation (29.4% vs 15.6%; p<0.001) and other professional activities (13.0% vs 4.8%; p=0.002). Nurses allocated significantly more time to therapeutic (22.3% vs 6.0% in physicians; p<0.001) and organisational activities (20.4% vs 9.5%; p<0.001). Overall mean interruption rate per hour was 10.16 (US ED: 8.15, German ED: 12.04; p<0.001). American physicians and German nurses were most often disrupted by colleagues of the same profession (country: B=-.27, p=0.027; profession: B=0.35, p=0.006). German ED staff were interrupted more often by patients (B=-.78, p=0.001) and other sources (B=-.76, p<0.001) than American ED staff.

Discussion Our findings corroborate that professional roles largely determine time allocation to specific activities. However, interruption rates indicate differences between countries, suggesting the need for context-specific solutions to work stressors.

  • emergency department
  • work activities
  • interruptions
  • cross-national research
  • work observations

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  • Handling editor Simon Carley

  • Contributors AS, MWeh and MWei conceptualised and designed the study. AS and MWei were responsible for acquisition of data. AS, DJW, CK and MWei analysed data. All authors interpreted the data regarding study hypotheses. All authors drafted, read and approved the final manuscript.

  • Funding The study was supported by the Munich Centre of Health Sciences (MC-Health).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Ethics Committee of the Medical Faculty, Munich University (NR 327–15) and the American ED’s academic institutional review board approved the study.

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

  • Data availability statement Anonymised and de-identified data will be made available to other investigators on reasonable request. Interested investigators should contact the corresponding author.