Physician Workflow in Two Distinctive Emergency Departments: An Observational Study

Area of Science:

• Healthcare Management
• Clinical Informatics
• Human Factors Engineering

Background:

• Physician workflow is a critical determinant of emergency department (ED) efficiency and patient safety.
• Electronic health records (EHRs) significantly influence physician activities and workflow patterns.
• Organizational complexity in healthcare settings can impact clinical practice and resource utilization.

Purpose of the Study:

• To characterize and compare physician workflow in two distinct emergency departments (EDs) with varying organizational complexity.
• To explore how electronic health record (EHR) use and team communication mediate physician practices within these EDs.
• To analyze the relationship between workflow patterns, organizational complexity, and efficiency in emergency care delivery.

Main Methods:

• Direct clinical observation of 14 physicians across 62 hours in two urban EDs (one academic teaching ED).
• Characterization of clinical activities including EHR use, team communication, and direct patient care.
• Qualitative open-coding analysis, descriptive statistics, and temporal event representation using timeline belts.

Main Results:

• Site 1 (complex ED) showed nonlinear, fragmented workflows with frequent multitasking and interruptions; physicians spent 61% time at workstations, but only 25% on EHRs.
• Site 2 (less complex ED) exhibited more linear workflows; physicians spent 52% time at workstations, with 31% dedicated to EHRs, primarily for chart review.
• Site 1 physicians engaged in more team communication, while Site 2 focused more on direct patient care.

Conclusions:

• Physician workflow and EHR-mediated practices are shaped by the specific ED environment and organizational complexity.
• More complex EDs may lead to less efficient, fragmented physician workflows.
• Team communication can mitigate inefficiencies and provide safety checks in complex clinical environments.