Emergency physicians' active patient queues over the course of a shift.

Autor: Joseph JW; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: jwjoseph@bidmc.harvard.edu., Davis SR; LogixHealth, Bedford, MA, USA., Wilker EH; Harvard School of Public Health, Boston, MA, USA., White BA; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Litvak O; LogixHealth, Bedford, MA, USA., Nathanson LA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Sanchez LD; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2021 Aug; Vol. 46, pp. 254-259. Date of Electronic Publication: 2020 Jul 29.
DOI: 10.1016/j.ajem.2020.07.049
Abstrakt: Objectives: When emergency physicians see new patients in an ad libitum system, they see fewer patients as the shift progresses. However, it is unclear if this reflects a decreasing workload, as patient assessments often span many hours. We sought to investigate whether the size of a physician's queue of active patients similarly declines over a shift.
Methods: Retrospective cohort study, conducted over two years in three community hospitals in the Northeastern United States, with 8 and 9-h shifts. Timestamps of all encounters were recorded electronically. Generalized estimating equations were constructed to predict the number of active patients a physician concurrently managed per hour.
Results: We evaluated 64 physicians over a two-year period, with 9822 physician-shifts. Across all sites, physicians managed an increasing queue of active patients in the first several hours. This queue plateaued in the middle of the shift, declining in the final hours, independently of other factors. Physicians' queues of active patients increased slightly with greater volume and acuity, but did not affect the overall pattern of work. Similarly, working alone or with colleagues had little effect on the number of active patients managed.
Conclusions: Emergency physicians in an ad libitum system tend to see new patients until reaching a stable roster of active patients. This pattern may help explain why physicians see fewer new patients over the course of a shift, should be factored into models of throughput, and suggests new avenues for evaluating relationships between physician workload, patient safety, physicians' well-being, and the quality of care.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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