Quantifying and Visualizing Emergency Physician Workflow: Observational Time-Motion Study

Emergency physicians face considerable workflow challenges in the emergency department (ED) due to unpredictable work environments, frequent interruptions, and mounting documentation requirements, all of which contribute to substantial computer-based work. Excessive time away from direct patient care is increasingly viewed as detrimental to the quality of care, communication, and patient safety.

This study aimed to quantify and visualize how emergency physicians allocate their time during ED shifts, particularly the time spent on the computer.

This cross-sectional observational time-motion study was conducted in a high-volume, urban ED. We used the validated TimeCaT application to continuously track physician activities, including computer use, direct patient care, communication, and all other tasks carried out during the shift. Electronic health record event log data were queried to estimate physicians' computer use after their scheduled shift. The main outcome was the proportion of time spent on each activity. The primary measure was the total minutes of computer use (during and after the shift) per scheduled hour of clinical work. Additionally, we generated data visualizations to illustrate ED workflow-sequencing, task switching, and between-shift variability.

We observed 20 emergency physicians for one 8- to 9-hour clinical shift each, generating over 150.0 hours of real-time observation data quantifying physicians' ED workflow. Physicians spent a median of 34.1% of their shift minutes using the computer (156.5, IQR 145.2-179.3 min) and 26.9% with patients (115.2, IQR 102.0-154.1 min). Other activities included 15.9% for verbal communication with staff (73.3, IQR 45.6-96.4 min), 9.5% phone use (41.4, IQR 33.4-59.2 min), 5.5% miscellaneous tasks (24.2, IQR 18.4-30.1 min), 3.9% personal time (16.8, IQR 9.9-25.4 min), 0.7% electrocardiogram review (3.8, IQR 1.4-5.0 min), and 0.4% other procedures (median 1.7, IQR 0.6-6.4 min). Electronic health record log analysis showed that physicians spent an additional median 1.3 (IQR 0.5-2.6) hours using the computer after their scheduled shifts, for a combined 29.8 (IQR 25.6-38.5) minutes on the computer per scheduled hour of their ED shift. Workflow visualizations showed frequent alternation among activity categories and noticeable variability in within-shift fragmentation across physicians.

Emergency physicians spent more than one-third of their ED shift working on the computer, which was more time than they spent with patients. They also spent 1 to 2 hours using the computer after their scheduled shift. These findings demonstrate the need for strategies to reduce unnecessary computer use during and after clinical shifts to enhance workflow efficiency and improve patient care.