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Abstract
Background The total time per patient doctors spend providing care in emergency departments (EDs) has implications for the development of evidence-based ED staffing models. We sought to measure the total time taken by doctors to assess and manage individual paediatric patients presenting to two EDs in the Western Cape, South Africa and to compare these averages to the estimated benchmarks used regionally to calculate ED staffing allocations.
Methods We conducted a cross-sectional, observational study applying time and motion methodology, using convenience sampling. Data were collected over a 5-week period from 11 December 2015 to 18 January 2016 at Khayelitsha District Hospital Emergency Centre and Tygerberg Hospital Paediatric Emergency and Ambulatory Unit. We assessed total doctor time for each patient stratified by acuity level using the South African Triage Scale.
Results Care was observed for a total of 100 patients. Median age was 21 months (IQR 8–55). Median total doctor time per patient (95% CI) was 31 (22 to 38), 39 (31 to 63), 48 (32 to 63) and 96 (66 to 122) min for triage categories green, yellow, orange and red, respectively. Median timing was significantly higher than the estimated local benchmark for the lowest acuity ‘green’ triage category (31 min (22 to 38) vs 15 min; p=0.001) and the highest acuity ‘red’ category (96 min (66 to 122) vs 50 min; p=0.002).
Conclusion Doctor time per patient increased with increasing acuity of triage category and exceeded estimated benchmarks for the highest and lowest acuities. The distinctive methodology can easily be extended to other settings and populations.
- efficiency
- emergency care systems
- emergency department
- management
- paediatrics
- paediatric emergency medicine
Data availability statement
Access is available upon reasonable request to individual participant data that underlie the results reported in this article, after deidentification. Data will be available from the corresponding author (contact details as specified), following the approval of a request by all the authors. Data will be available immediately following publication, and with no end date. Data may be accessed and used subject to the principles of data confidentiality and security described in the study protocol, which is additionally available on request.
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- efficiency
- emergency care systems
- emergency department
- management
- paediatrics
- paediatric emergency medicine
Data availability statement
Access is available upon reasonable request to individual participant data that underlie the results reported in this article, after deidentification. Data will be available from the corresponding author (contact details as specified), following the approval of a request by all the authors. Data will be available immediately following publication, and with no end date. Data may be accessed and used subject to the principles of data confidentiality and security described in the study protocol, which is additionally available on request.
Footnotes
Handling editor Simon Carley
Twitter @RobStellman, @PEM_CT
Contributors RS conducted the data collection, acted as the time and motion observer, prepared the initial drafts of the proposal and the manuscript, and developed these with BC and AR. AR helped draft the research proposal and methodology, was involved in reviewing and interpreting the results, and drafting and revising the final manuscript. TE designed and conducted the statistical analyses, supported their interpretation and presentation through multiple drafts, and was involved in editing the final manuscript. SL reviewed the results and statistical analysis; provided specific input regarding their practical clinical significance, and made general contributions to the entirety of the final manuscript. BC was involved in the original inception of the research idea, she helped draft the research proposal and methodology, was involved in reviewing and interpreting the results, and drafting and revising the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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