[Time-allocation study of nurse and physician activities in the emergency department]

Comprehensive and systematic assessments of nurse and physician activities in the emergency department (ED) are lacking for German-speaking countries.

Assessment of work activities of ED nurses and physicians with particular focus on frequencies of direct patient contact as well as rates of activity changes.

We employed standardized assessments of work activities using participant observations (90 min each) among nurses and physicians during their regular shifts. The setting was an interdisciplinary ED of a Southern German academic hospital. Observed activities were classified according to an established system and recorded with time stamps. Overall, 160 observation sessions were conducted (with an observation time of approximately 240 h; 99 among nurses, 61 among physicians).

Physicians spent 30% of their working time in direct patient contact, nurses 44%. Concerning individual activities, the largest proportions of physicians' work time were allocated to documentation and writing (29.3%), communication with ED staff (16.9%) and patients (13.6%). Nurses were engaged in therapeutic and treatment activities (27.6%) and internal communication (17.9%) most of the time. Individual activities were highly fragmented: On average, we recorded 41.3 activities per hour with an average duration of 1.5 min. Nurses had significantly shorter activity durations than ED physicians (F[df = 1] = 4.5, p = 0.04). Activity-specific subanalyses revealed differences that could be attributed to professional roles in ED work.

Our results provide reliable and comprehensive insights into the distribution and duration of physician and nurse activities in clinical care in a German ED. Future work and design projects should focus particularly on effects of ED work time allocation on performance and work stress of ED staff as well as on safety and quality of ED patient care.