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An attending physician float shift for the improvement of physician productivity in a crowded emergency department
Muhammad Umer Nasim1, Chintan Mistry1, Robert Harwood1
1Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA.
Insights
Implementing a dedicated "float shift" for emergency department (ED) boarding patients increased physician productivity by 1.1 patients per shift. This strategy improved physician efficiency despite high patient volumes and diversion times.
Area of Science:
- Emergency Medicine
- Healthcare Operations
- Patient Flow Management
Background:
- Emergency department (ED) crowding is exacerbated by patients awaiting inpatient beds (boarders).
- Boarding patients require ED physician attention, impacting overall ED capacity.
- A novel
- float shift
- was introduced to manage boarding patients.
Purpose of the Study:
- To quantify the impact of a dedicated float shift on physician productivity in the ED.
- To test the hypothesis that a float shift improves physician efficiency.
Main Methods:
- A retrospective observational study was conducted in a community hospital ED.
- New patient encounters per shift were compared between periods with and without a scheduled float shift physician.
- Data were collected during February (float shift present) and May (float shift absent) of 2008.
Main Results:
- Physician productivity increased, with a mean rise of 1.1 new patients seen per shift when the float shift was active.
- Despite similar overall patient volumes, the float shift positively impacted patient throughput.
- Physician support for the float shift varied, with 92% of residents and 65% of attending physicians favoring its continuation.
Conclusions:
- A dedicated float shift for boarding patients enhances the productivity of other ED physicians.
- This operational change improves ED physician efficiency even amidst high patient volumes and diversion.
- The float shift is a viable strategy for mitigating the negative effects of ED boarding on physician workload and patient care.
Background:
Patients backlogged in the emergency department (ED) waiting for an inpatient bed (boarders) continue to require the attention of ED physicians, exacerbating crowding in the ED. To address this problem, we added a "float shift" to our winter schedule solely to care for boarders. We sought to quantify the effect of this float shift, hypothesizing greater physician productivity.
Methods:
We performed a retrospective observational study in our community hospital ED, measuring the number of new patients seen in each 10-hour shift in the presence or absence of a float shift physician. We calculated the number of new patients seen per shift for each of the 7 daily shifts, during February (float shift scheduled) and May (float shift unscheduled) of 2008. We then compared the mean number of patients seen per shift in February with May.
Results:
Total monthly patient volume was 6 656 for February and 6 775 for May, with the mean daily census being 230 and 219 patients, respectively. The number of new patients seen during each shift was greater in February than in May, with a mean increase of 1.1 patients per shift (with the float shift). Surveying participants about intervention effectiveness showed 92% of residents, but only 65% of attending physicians, in favor of maintaining the float shift.
Conclusion:
The presence of a "float shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED, despite the presence of longer throughput times and increased time on diversion.
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