Activities of accident and emergency consultants--a time and motion study

The work of an accident and emergency (A&E) consultant is not clearly defined. There is difficulty in fixing a job plan due to the unpredictable workload. This study shows the daily activities of nine consultants in A&E over a one month period. The results suggest that A&E consultants vary tremendously in the content of their working day, although a large proportion of hours is spent on administrative duties in all cases. Predictable variations occur between a single handed clinical director who spends 60% of his time in management and the consultant in a multiconsultant department who spends 74% of his time in clinical care and teaching. None of the consultants studied spent more than 48% of their time in clinical contact. A&E remains a specialty with no consistency between activities of consultants, and where opportunities exist to pursue special interest. Training must ensure adequate attention to management and methods of support for new consultants in their management role must be found.