One hundred tasks an hour: An observational study of emergency department consultant activities

Abstract

Objective: To determine work activity patterns undertaken by ED consultants. Methods: A single observer time‐motion study of consultants rostered to clinical shifts: primarily administrative (Duty) or clinical (Resuscitation). Direct observation of 130 h was undertaken using purpose developed time‐stamping software. Primary outcome was task number and time spent in predetermined categories of activity. Comparisons occurred by role delineation, sex, weekday and time of day. Results: For each observed hour consultants performed 101 discrete tasks. A high proportion was spent multitasking; 77 min of overlapping activity in each hour of observation. Consultants spent 42% of each hour on communication, 35% on direct clinical care and 24% on computer use; only 9% was spent on non‐clinical tasks. Consultants spent little time (0.6%) accessing e‐resources. Duty consultants undertook more tasks than Resuscitation consultants, 111 versus 90, and more time was spent on communication (47% vs 35%) and computer use (32% vs 15%) with less on clinical care (29% vs 43%). Female consultants undertook 119 tasks per hour compared with 93 for male consultants; more time was spent on communication (51% vs 38%) and computer use (28% vs 22%). No difference in activity occurred by time of day or weekday. Conclusion: ED consultants have very high hourly task rates dominated by communication and clinical activities and frequently multitask. The activity is relatively constant throughout the week but is influenced by sex and role delineation. Appreciation of activity distribution might allow informed interventions to realign the workload or divert tasks to supporting resources.

Understanding better how emergency doctors work. Analysis of distribution of time and activities of emergency doctors: a systematic review and critical appraisal of time and motion studies

“…Similarly, Kee et al reported that consultants undertook more than 100 tasks an hour 15. This is higher than the 34 tasks per hour as reported by France et al 26 or 80 tasks per working day as reported by Mache et al 21…”

“…Sometimes it was reported as charting or dictation,17 24 26 paperwork22 27 or ‘data’19 but it basically referred to the recording of patient information on paper, or on the computer. Time spent on documentation ranged from around 10% in the Australian study by Kee et al 15 to as high as 28% according to Chisholm et al 16. In four studies, documentation occupied more than 20% of the senior doctors’ time 16 17 22 26…”

Occupational stress in the ED: a systematic literature review

“…A Swedish study also identified that information exchange was the most common ED activity to be multitasked 56. Gender differences in communication loads for ED consultants suggest that females engage in higher activity 57. ED physicians have been shown to encounter up to 15 interruptions per hour, with senior doctors and nurses more frequently affected 58 59…”

Emergencies and Disaster Medicine

“…Le modèle qui définit l'encombrement des urgences sanitaires suit alors l'évolution [entrée patient (urgent et non urgent) → soins urgents et non urgents → sortie] [26][27][28]. [29] KeeR and al a objectivé que chaque personnel des services des urgences réalise 101 tâches par heure ; 42% en communication, 35% en attitudes de soin clinique et 24% à l'usage de l'ordinateur et seulement 9% en attitudes non cliniques. L'activité médicale est potentiellement dangereuse : c'est ce qu'a mis en évidence le rapport « To err is human » en 2000 aux États-Unis [30].…”