Modelling attending physician productivity in the emergency department: a multicentre study

Area of Science:

• Emergency Medicine
• Healthcare Operations Research

Background:

• Physician productivity is crucial for hospital operations.
• Previous studies indicated resident physicians' productivity decreases during shifts.
• Attending physician productivity dynamics remained largely unexamined.

Purpose of the Study:

• To investigate if attending physician productivity also decreases hourly throughout shifts.
• To quantify the hourly changes in physician productivity.
• To inform clinical operations and staffing models.

Main Methods:

• Retrospective cohort study (2014-2016) across three US community hospitals.
• Electronic health record data used to log patient encounter timestamps.
• Generalized estimating equations applied to predict new patients per shift hour.

Main Results:

• Data from 64 physicians and 207,169 patients across 9,822 shifts analyzed.
• Physician productivity significantly decreased after the first hour of a shift.
• Higher patient arrivals increased productivity, but this effect diminished late in shifts.

Conclusions:

• Attending physician productivity follows a predictable hourly decline.
• Average productivity metrics underestimate early-shift capacity and overestimate later-shift capacity.
• Hospitals should align staffing with observed productivity patterns, starting shifts with peak patient arrivals.