Shifting Toward Balance: Measuring the Distribution of Workload Among Emergency Physician Teams - 15/08/11
, Dominik Aronsky, MD, PhD c, d, Robin Hemphill, MD, MPH c, Jin Han, MD c, Jason Slagle, PhD b, Daniel J. France, PhD, MPH a, b, c
Address for correspondence: Scott Levin, MS, Vanderbilt University, Center for Perioperative Research in Quality, 1211 21st Ave S, Ste 732, Nashville, TN 37212-1212; 301-404-7742, fax 615-936-7373Résumé |
Study objective |
The objective of this investigation is to determine time-dependent workload patterns for emergency department (ED) physician teams across work shifts. A secondary aim was to demonstrate how ED demand patterns and the timing of shift changes influence the balance of workload among a physician team.
Methods |
Operational measurements of an adult ED were collected from a clinical information system to characterize physician workload patterns during all current work shifts. Plots of patient load versus time were developed for each physician shift, in which patient load was defined as the number of patients a physician simultaneously managed at a point in time. Patient-load curves for each shift were superimposed during 24 hours to display how patient load was distributed among a team of physicians.
Results |
Resident shift changes during daily peak occupancy periods caused patient load imbalances so that residents on a particular shift consistently managed a disproportionate number of patients (mean 9.4 patients; 95% confidence interval [CI] 6.7 to 12.1 patients) compared with other residents on duty (mean 3.4 patients; 95% CI 2.1 to 4.7 patients).
Conclusion |
Physician patient load patterns and ED demand patterns should be taken into consideration when physician shift times are scheduled so that patient load may be balanced among a team. Real-time monitoring of physician patient load may reduce stress and prevent physicians from exceeding their safe capacity for workload.
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| Supervising editor: Robert L. Wears, MD, MS |
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| Author contributions: SL and DJF conceived and designed the study. DA, RH, and JH provided advice on data analyses and interpretation. DA provided access to and answered questions about the ED information system. SL drafted the article, and DA, RH, JH, JS, and DF contributed substantially to its revision. SL takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Mr. Levin is supported by the National Science Foundation, Integrative Graduate Education and Research Traineeship Program, and an Idaho National Laboratory Graduate Fellowship. Dr. Aronsky is partially supported by NLM 1R21 LM009002-01. |
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| Available online June 7, 2007. |
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| Reprints not available from the authors. |
Vol 50 - N° 4
P. 419-423 - octobre 2007 Retour au numéro
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