Prospective time study derivation of emergency physician workload predictors

Area of Science:

• Emergency Medicine
• Health Services Research
• Clinical Operations

Background:

• Emergency department (ED) workload measurement is crucial for performance evaluation, incentive programs, and equitable staffing.
• Current methods often rely solely on patient volume and perceived acuity, lacking precision.

Purpose of the Study:

• To identify predictors of physician time spent per patient visit in the ED.
• To develop and validate a multivariable model for predicting emergency physician workload.

Main Methods:

• A research assistant shadowed 20 physicians across 31 shifts, documenting 585 patient visits.
• Data collected included patient demographics, vital signs, Glasgow Coma Scale (GCS), arrival mode, triage level, comorbidities, and procedures.
• Multiple linear regression was used to derive and validate a predictive equation for total physician time per patient visit (TPPV).

Main Results:

• Key predictors of physician TPPV included: procedures required, triage level, ambulance arrival, GCS, age, comorbidities, and prior visits.
• The derived regression equation explained 31.3% of the variance in physician TPPV (p < 0.0001).

Conclusions:

• The study identified significant determinants of emergency physician workload.
• The validated predictive formula offers a potential evidence-based alternative to simplistic workload models.
• This tool can enhance ED productivity measurement, benchmarking, performance evaluation, and staffing estimations.