HOW DO PHYSICIANS AND NURSES SPEND THEIR TIME IN THE EMERGENCY DEPARTMENT

Study objectives: To determine how emergency physicians and nurses spe nd their time on emergency department activities. Methods: An observat ional time-and-motion study was performed al a 36-bed ED with annual c ensus of 84,000 in a central city teaching hospital sponsoring an emer gency medicine residency program. Participants were emergency medicine faculty physicians, second- and third-year emergency medicine residen t physicians, and emergency nurses. A single investigator followed ind ividual health care providers for 180-minute periods and recorded time spent on various activities, type and number of activities, and dista nce walked. Activities were categorized as direct patient care (eg, hi story and physical examination), indirect patient care (eg, charting), or nonpatient care (eg, break time). Results: On average, subjects sp ent 32% of their time on direct patient care, 47% on indirect patient care, and 21% on non-patient care. Faculty physicians, residents, and emergency nurses differed in the time spent on these three categories of activities. Although the overall time spent on direct patient care activities was not significantly different, emergency nurses spent mor e of their time (2.2%) providing comfort measures (a subcategory of di rect patient care) than did faculty physicians (.05%) or resident phys icians (.03%). Emergency nurses spent 38.9% of their time performing i ndirect care, whereas faculty physicians spent 51.3% and resident phys icians 53.7%. Resident physicians spent more time charting than did fa culty physicians or emergency nurses (21.4%, 11.9%, and 6.9%, respecti vely). Emergency nurses spent more time on personal activities than di d physicians, and faculty physicians walked less than either emergency nurses or resident physicians. Conclusion: Emergency physicians and n urses spent almost half of their time on indirect patient care. Physic ians spent significantly more time on indirect patient care activities and significantly less time on personal activities than did nurses.