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Understanding better how emergency doctors work. Analysis of distribution of time and activities of emergency doctors: a systematic review and critical appraisal of time and motion studies
  1. Maysam Ali Abdulwahid,
  2. Andrew Booth,
  3. Janette Turner,
  4. Suzanne M Mason
  1. School of Health and Related Research, University of Sheffield, Sheffield S1 4DP, UK
  1. Correspondence to Dr Maysam Ali Abdulwahid, School of Health and Related Research, University of Sheffield, Sheffield S1 4DP, UK; m.abdulwahid{at}leeds.ac.uk

Abstract

Background Optimising the efficiency and productivity of senior doctors is critical to ED function and delivery of safe patient care. Time and motion studies (TMS) can allow quantification of how these doctors spend their working time, identify inefficiencies in the current work processes and provide insights into improving working conditions, and enhancing productivity. Three questions were addressed: (1) How do senior emergency doctors spend their time in the ED? (2) How much of their time is spent on multitasking? (3) What is the number of tasks completed per hour?

Methods The literature was systematically searched for TMS of senior emergency doctors. We searched for articles published in peer-reviewed journals in English language from 1998 to 2018 in the following databases: MEDLINE, EMBASE, Scopus, Web of Science and Cochrane. Studies were assessed for methodological quality using evidence-based quality criteria relevant for TMS including duration of observation, observer bias, Hawthorne effect and whether the task classification acknowledged any previous existing schemes. A narrative synthesis approach was followed.

Results Fourteen TMS were included. The studies were liable to several biases including observer and Hawthorne bias. Overall, the time spent on direct face-to-face contact with the patient accounted for at least around 25%–40% of the senior doctors’ time. The remaining time was mostly spent on indirect clinical care such as communication (8%–44%), documentation (10%–28%) and administrative tasks (2%–20%). The proportion of time spent on multitasking ranged from 10% to 23%. When reported, the number of tasks performed per hour was generally high.

Conclusion The review revealed that senior doctors spent a large percentage of their time on direct face-to-face contact with patients. The review findings provided a grounded understanding of how senior doctors spent their time in the ED and could be useful in implementing improvements to the emergency care system.

  • emergency care systems, efficiency
  • emergency department
  • clinical care
  • emergency care systems, emergency departments

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Footnotes

  • Contributors MAA undertook the systematic review. All authors contributed to the concept and design of the study, contributed to the interpretation of the study findings, and revised it critically and approved the final version submitted.

  • Funding This paper was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH). http://www.clahrc-yh.nir.ac.uk. The views and opinions expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Disclaimer The views and opinions expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

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

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