EMERGENCY PHYSICIAN WORKLOAD - A TIME STUDY

Study hypothesis: Physician service time varies with patient service c ategory, length of stay, and intensity of service. Design: Prospective time study of emergency physician services. Physicians recorded the b eginning and ending times of each service episode offered to a patient (whether at the bedside or occurring elsewhere in the department). Ea ch episode was defined as an ''interaction,'' with the total service t ime offered to a patient being the sum of all interactions for that pa tient. Length of stay was the time interval from when the patient regi stered in the emergency department to when the patient was released. I ntensity of service was calculated as service time divided by length o f stay. Setting: University-affiliated community teaching hospital. Ty pe of participants: One thousand three hundred forty-seven ED patients were entered into the study for nonselected (514), walk-in (637), obs ervation (52), laceration repair (102), or critical care (42) services . Six of 12 physicians in the group staffing the ED participated in th e study. Patient data were entered onto study cards when the service w as offered. Patients were entered into the study consecutively except when the physician became too busy to see one patient at a time and ac curately enter time data; such interruptions occurred for 18% of the p atients. Results: Physician service time for nonselected service patie nts (24.2 minutes per patient; 95% CI, 23.1-25.3) was consistent with ACEP's findings for nonselected services offered by emergency physicia ns (22 minutes per patient). Physician service time did not vary signi ficantly from the standard for laceration repair patients (25.0 minute s per patient; 95% Cl, 22.6-27.4) but did vary significantly from the standard for walk-in (9.8 minutes per patient; 95% CI, 9.3-10.3; P < . 05), observation (55.6 minutes per patient; 95% CI, 50.7-60.5; P < .05 ), and critical care patients (31.9 minutes per patient; 95% Cl, 26.2- 37.6; P < .05). Walk-in and laceration repair patients had a single ph ysician-patient interaction (1.3 per patient and 1.1 per patient, resp ectively), consistent with a discrete service offered during episodic care. Observation and critical care patients had multiple physician-pa tient interactions (6.3 per patient and 2.6 per patient, respectively) over an extended period, which is consistent with additional services being offered during their period of observation/holding, Conclusion: Case mix of patient services affects emergency physician workload and should be considered in planning departmental staffing needs.