Emergency Department Crowding and Time at the Bedside: A Wearable Technology Feasibility Study

Area of Science:

• Emergency Medicine
• Health Services Research
• Medical Informatics

Background:

• Emergency department (ED) crowding presents a significant public health challenge, impacting care quality and access.
• Understanding the dynamics of clinician-patient interactions during high occupancy is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the feasibility of using radio-frequency identification (RFID) tags for measuring clinician-patient contact in the ED.
• To investigate the correlation between ED occupancy levels and the duration/frequency of clinician-patient contact.

Main Methods:

• A 4-week observational study in an urban teaching hospital ED involving RFID tags worn by clinicians.
• Merging time-motion data with electronic health records for 3,237 patients, adjusting for covariates.
• Conducting focus groups (N=39) to gather qualitative insights on the quantitative findings.

Main Results:

• Increasing ED occupancy correlated with more frequent room entries/exits for attending physicians (P=0.03).
• No significant associations were found between occupancy and contact time/encounters for nurses, residents, or advanced practice providers.
• Qualitative data revealed that while contact quantity remained stable for non-physicians, care quality was perceived to decline with increased crowding.

Conclusions:

• Wearable tracking technology faces limitations in the ED due to environmental and privacy concerns.
• Higher ED occupancy leads to fragmented care from attending physicians.
• Nurses and other clinicians perceive a decrease in care quality, not just contact quantity, as EDs become more crowded.