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How much time do doctors spend providing care to each child in the ED? A time and motion study
  1. Robert Stellman1,2,
  2. Andrew Redfern3,
  3. Sa'ad Lahri4,5,
  4. Tonya Esterhuizen6,
  5. Baljit Cheema7
  1. 1Department of Emergency Medicine, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK
  2. 2Department of Paediatrics, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK
  3. 3Department of Paediatric and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
  4. 4Khayelitsha Hospital Emergency Centre, Western Cape, South Africa
  5. 5Division of Emergency Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
  6. 6Division of Epidemiology and Biostatistics, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
  7. 7Division of Emergency Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
  1. Correspondence to Dr Robert Stellman, Department of Emergency Medicine; Department of Paediatrics, Barnet Hospital, London, UK; rstellman{at}nhs.net

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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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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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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