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

Measurement of Human Resource Demand of Medical Institution Inspection Based on Task Analysis

Purpose

To estimate the human resource demand of health inspection agencies to carry out the medical institution inspection function, and to provide the basis for the rational allocation of health inspection human resources.

Methods

Through policy documents review, inquiry of data from national health inspection report, Shanghai Health Inspection core business system, the basic data were collected. Based on the task analysis, the inspection functions of health inspection agency were investigated. The functional work links were analyzed, and the working time consumption was measured. The manpower needed to complete the inspection tasks of medical institutions was calculated combining with the annual functional workload and the effective working time of inspectors.

Results

There were three main routine functions of medical institution inspection, namely, on-site inspection, administrative punishment, and handling of emergencies and complaints. There were 1871 medical institutions at all levels and types in Pudong New Area, with an average annual inspection frequency of 2.8 times, annual administrative penalty of 245 cases, and handling of emergencies and complaints of 330 cases. The total time required for functional work was 1656029.30 minutes, and the annual effective working time of single inspector was 66705.21 minutes. About 25 people were taken to complete the inspection tasks of medical institutions throughout the year. The number of personnel engaged in the inspection of medical institutions was 18, and the personnel gap was 7.

Conclusion

The task analysis was an effective method to estimate the human resource demand of health inspection. In Pudong New Area, there were insufficient inspectors in medical institutions. In the case of insufficient human resource supplement, it was suggested to use technical means to improve work efficiency and save manpower investment.

How much time do doctors spend providing care to each child in the ED? A time and motion study

BACKGROUND

The total time per patient doctors spend providing care in emergency departments (EDs) has implications for the development of evidence-based ED staffing models. We sought to measure the total time taken by doctors to assess and manage individual paediatric patients presenting to two EDs in the Western Cape, South Africa and to compare these averages to the estimated benchmarks used regionally to calculate ED staffing allocations.

METHODS

We conducted a cross-sectional, observational study applying time and motion methodology, using convenience sampling. Data were collected over a 5-week period from 11 December 2015 to 18 January 2016 at Khayelitsha District Hospital Emergency Centre and Tygerberg Hospital Paediatric Emergency and Ambulatory Unit. We assessed total doctor time for each patient stratified by acuity level using the South African Triage Scale.

RESULTS

Care was observed for a total of 100 patients. Median age was 21 months (IQR 8-55). Median total doctor time per patient (95% CI) was 31 (22 to 38), 39 (31 to 63), 48 (32 to 63) and 96 (66 to 122) min for triage categories green, yellow, orange and red, respectively. Median timing was significantly higher than the estimated local benchmark for the lowest acuity 'green' triage category (31 min (22 to 38) vs 15 min; p=0.001) and the highest acuity 'red' category (96 min (66 to 122) vs 50 min; p=0.002).

CONCLUSION

Doctor time per patient increased with increasing acuity of triage category and exceeded estimated benchmarks for the highest and lowest acuities. The distinctive methodology can easily be extended to other settings and populations.

Overload of Medical Documentation: A Disincentive for Healthcare Professionals

This review addresses the theories concerning the development and functioning of medical bureaucracy creating an excess of the patient records. An ever-growing number of medical files comply with the typical development of the bureaucratic management of an entrepreneurial organization, an essential feature of which is the life cycle of documentation. When the life cycle ends, an update is created with a multiplication of forms and items to be filled out, resembling that of what happens with the outdated computer program. Yet medical records should have a logical and well-functioning structure using the language of computer science in the form of a cascade or evolutionary model. Further, we believe that mass computerization, in contradistinction to the primary predestination purpose, increases the number of time-consuming medical records, with the evidence that it enhances the occupational burnout among physicians. Clear and concise medical documentation is necessary to handle economic and legal issues in medicine. However, the creation of medical records sits at the crux between a health-conscious provision of the best evidence-driven treatment and the continuum of care and a potential health detriment caused by taking away the time and care devoted to the patient by healthcare professionals. We submit that the hitherto pattern of creating medical records requires a turnabout to attain the intended reasons and user-friendliness for practical ends.

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Background

Multitasking is a key skill for emergency department (ED) providers. Yet, potentially beneficial or debilitating effects for provider functioning and cognition are underexplored. We therefore aimed to investigate the role of multitasking for ED physicians’ work stress and situation awareness (SA).

Methods

Two consecutive, multi-source studies utilizing standardized expert observations in combination with physicians’ self-reports on stress and SA were set out in an academic ED. To control for ED workload, measures of patient acuity, patient counts, and ED staff on duty were included. Regression analyses estimated associations between observed proportion of time spent in multitasking with matched ED physicians’ reports on stress (study 1) and SA (study 2).

Results

ED physicians engaged between 18.7% (study 1) and 13.0% (study 2) of their worktime in multitasking. Self-reported as well as expert-observed multitasking were significantly associated. This confirms the internal validity of our observational approach. After controlling for ED workload, we found that physicians who engaged more frequently in multitasking perceived higher work stress (Beta = .02, 95%CI .001–.03; p = .01). In study 2, ED physicians with more frequent multitasking behaviors reported higher SA (B = .08, 95%CI .02–.14; p = .009).

Conclusions

Multitasking is often unavoidable in ED care. Our findings suggest that ED physicians’ multitasking increases stress experiences, yet, may facilitate professional’s experiences of situation awareness. Our results warrant further investigation into potentially ambivalent effects of ED providers’ multitasking in effectively sharing time between competing demands while maintaining performance and safety.

Understanding the role of Foundation doctors through a self-reported time-mapping pilot study

INTRODUCTION

There is a reduction in Foundation trainee applications to speciality training and this is attributed to an administrative job role, with subsequent fears of burnout. This pilot study presents the findings of a real-time self-reporting tool to map a group of Foundation doctors' elective activities. Self-reporting is efficient, low cost to run and allows for repeated measures and scalability. It aimed to example how a time-map could be used by departments to address any work imbalances and improve both well-being and future workforce planning.

METHOD

Foundation doctors', at a busy District General Hospital, were asked to contemporaneously report their work activities over an 'elective' day. Outcomes measures included the mean duration per task and the time of day these were performed.

RESULTS

Nine Foundation doctors' returned 26 timesheet days. Foundation doctors' time was split between direct patient tasks (18.2%, 106.8 min per day), indirect patient tasks (72.9%, 428.6 min per day) and personal or non-patient activities. Indirect tasks were the most frequent reason for Foundation doctors leaving late. No clinical experience was recorded at all and only an average of 4% (23.4 min per day) of a Foundation doctors' time was spent in theatre.

CONCLUSIONS

This particular cohort performed a high proportion of indirect tasks. These have been associated with burnout. Time-mapping is a low-cost, acceptable and seemingly scalable way to elucidate a clearer understanding of the type of activities Foundation doctors may perform. This methodology could be used to modernise the traditional Foundation doctor job description.

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

Hintergrund

Systematische und vergleichende Analysen der Tätigkeiten des ärztlichen und pflegerischen Personals in der Notaufnahme fehlen für den deutschsprachigen Bereich.

Ziel der Arbeit

Analyse der Aktivitäten des pflegerischen und ärztlichen Personals einer Notaufnahme sowie der Anteile direkten Patientenkontakts und stündlicher Tätigkeitswechsel.

Material und Methoden

Tätigkeitsanalysen auf Basis teilnehmender Beobachtungen (je 90 min) bei Pflegekräften und Ärzt*innen einer interdisziplinären Notaufnahme eines süddeutschen Krankenhauses der Maximalversorgung. Beobachtete Tätigkeiten wurden anhand eines Klassifikationssystems mitsamt Zeitdauern kodiert. Insgesamt wurden 160 Einzelbeobachtungen (mit einer Gesamtzeit von ca. 240 h) durchgeführt; 99 bei Pflegekräften sowie 61 bei Ärzt*innen.

Ergebnisse

Notaufnahmeärzt*innen arbeiten 30 % ihrer Zeit in direktem Patientenkontakt, Pflegekräfte hingegen 44 %. Für die Einzeltätigkeiten entfielen die größten Zeitanteile ärztlicher Tätigkeit auf Dokumentation und Schriftarbeit (29,3 %), interne Kommunikation mit Personal (16,9 %) sowie mit Patient*innen (13,6 %). Pflegekräfte verwenden die meiste Zeit auf therapeutische und Behandlungsaktivitäten (27,6 %) sowie interne Kommunikation (17,9 %). Diese Tätigkeiten waren stark fragmentiert: Im Durchschnitt erfassten wir 41,3 Einzeltätigkeiten pro Stunde mit einer durchschnittlichen Dauer von 1,5 min. Pflegekräfte hatten signifikant kürzere Tätigkeitsdauern als Ärzt*innen (F[df = 1] = 4,5; p = 0,04). Tätigkeitsspezifische Analysen ergaben weitere Professionsunterschiede.

Diskussion

Unsere Ergebnisse liefern erstmalig fundierte Einsichten in die Verteilung und Dauer von ärztlichen sowie pflegerischen Tätigkeiten in der akutmedizinischen Versorgung in der Notaufnahme. Zukünftige Arbeiten sollten sich insbesondere einhergehenden Auswirkungen auf die Leistungsfähigkeit und Beanspruchung des Personals wie auch der Sicherheit und Qualität der Versorgung widmen.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00063-020-00657-4) enthält die Tabelle S1. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.