Background: Emergency physicians face considerable workflow challenges due to unpredictable work environments, frequent interruptions, and mounting documentation requirements. Excessive time away from direct patient care is increasingly viewed as detrimental to care quality, communication, and patient safety. This study aimed to quantify and visualize the time emergency physicians spend on specific activities during their clinical shifts, particularly computer usage. Methods: This observational time-motion study was conducted in a high-volume, urban emergency department (ED). An observer used a web-based application to track physician activities including computer use, direct patient care, and all other major tasks carried out on shift. Electronic health record (EHR) event log data was queried to measure computer use after each physician′s scheduled shift. The primary outcome was total minutes of computer time (during and after shift) per scheduled hour of clinical work. Results: The observer tracked 20 emergency physicians for one 8-9h clinical shift each, which generated 150.0 hours of real-time observation data quantifying physicians′ ED workflow. In total, emergency physicians spent a median 29.8 minutes (IQR 25.6-38.5) on the computer per scheduled hour of their ED shift. Physicians spent a median 34.1% of their shift time using the computer and 26.9% with patients. Other activities included verbal communication with staff (15.9%), phone use (9.5%), miscellaneous tasks (5.5%), personal time (3.9%), electrocardiogram review (0.7%), and procedures (0.4%). EHR log analysis showed that physicians spent an additional median 1.3h (IQR 0.5-2.6) using the computer after their scheduled shifts. Conclusion: 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 1-2 hours using the computer after their shifts. These findings demonstrate the need for strategies aimed at reducing unnecessary computer use during and after clinical shifts to enhance efficiency and improve patient care.
