Modelling attending physician productivity in the emergency department

a multicentre study

Joshua W. Joseph, Samuel Davis, Elissa H. Wilker, Matthew L. Wong, Ori Litvak, Stephen Traub, Larry A. Nathanson, Leon D. Sanchez

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)317-322
Number of pages6
JournalEmergency medicine journal : EMJ
Volume35
Issue number5
DOIs
StatePublished - May 1 2018

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Multicenter Studies
Hospital Emergency Service
Physicians
Electronic Health Records
Community Hospital
Appointments and Schedules
Emergencies
Cohort Studies
Retrospective Studies
Research

Keywords

  • care systems
  • crowding
  • emergency department operations
  • operational
  • staff support

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Modelling attending physician productivity in the emergency department : a multicentre study. / Joseph, Joshua W.; Davis, Samuel; Wilker, Elissa H.; Wong, Matthew L.; Litvak, Ori; Traub, Stephen; Nathanson, Larry A.; Sanchez, Leon D.

In: Emergency medicine journal : EMJ, Vol. 35, No. 5, 01.05.2018, p. 317-322.

Research output: Contribution to journalArticle

Joseph, JW, Davis, S, Wilker, EH, Wong, ML, Litvak, O, Traub, S, Nathanson, LA & Sanchez, LD 2018, 'Modelling attending physician productivity in the emergency department: a multicentre study', Emergency medicine journal : EMJ, vol. 35, no. 5, pp. 317-322. https://doi.org/10.1136/emermed-2017-207194
Joseph, Joshua W. ; Davis, Samuel ; Wilker, Elissa H. ; Wong, Matthew L. ; Litvak, Ori ; Traub, Stephen ; Nathanson, Larry A. ; Sanchez, Leon D. / Modelling attending physician productivity in the emergency department : a multicentre study. In: Emergency medicine journal : EMJ. 2018 ; Vol. 35, No. 5. pp. 317-322.
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