Department of Emergency Medicine, Indiana University School of Medicine, and Methodist Hospital,1701 N Senate Blvd, Indianapolis, IN 46202, USA.
Ann Emerg Med. 2011 Aug;58(2):117-22. doi: 10.1016/j.annemergmed.2010.11.026. Epub 2011 Jan 28.
We characterize and compare the work activities, including peak patient loads, associated with the workplace in the academic and community emergency department (ED) settings. This allows assessment of the effect of future ED system operational changes and identifies potential sources contributing to medical error.
This was an observational, time-motion study. Trained observers shadowed physicians, recording activities. Data included total interactions, distances walked, time sitting, patients concurrently treated, interruptions, break in tasks, physical contact with patients, hand washing, diagnostic tests ordered, and therapies rendered. Activities were classified as direct patient care, indirect patient care, or personal time with a priori definitions.
There were 203 2-hour observation periods of 85 physicians at 2 academic EDs with 100,000 visits per year at each (N=160) and 2 community EDs with annual visits of 19,000 and 21,000 (N=43). Reported data present the median and minimum-maximum values per 2-hour period. Emergency physicians spent the majority of time on indirect care activities (academic 64 minutes, 29 to 91 minutes; community 55 min, 25 to 95 minutes), followed by direct care activities (academic 36 minutes, 6 to 79 minutes; community 41 minutes, 5 to 60 minutes). Personal time differed by location type (academic 6 minutes, 0 to 66 minutes; community 13 minutes, 0 to 69 minutes). All physicians simultaneously cared for multiple patients, with a median number of patients greater than 5 (academic 7 patients, 2 to 16 patients; community 6 patients, 2 to 12 patients).
Emergency physicians spend the majority of their time involved in indirect patient care activities. They are frequently interrupted and interact with a large number of individuals. They care for a wide range of patients simultaneously, with surges in multiple patient care responsibilities. Physicians working in academic settings are interrupted at twice the rate of their community counterparts.
我们对学术和社区急诊科（ED）工作场所的工作活动（包括高峰患者量）进行描述和比较。这可以评估未来 ED 系统运行变化的影响，并确定导致医疗差错的潜在来源。
这是一项观察性的时间-动作研究。经过培训的观察员跟踪医生，记录活动。数据包括总互动次数、行走距离、坐着时间、同时治疗的患者人数、中断次数、任务中断次数、与患者的身体接触次数、洗手次数、所开诊断性检查次数和所提供治疗次数。活动分为直接患者护理、间接患者护理或个人时间，采用事先定义。
对 2 所学术 ED 的 85 名医生进行了 203 个 2 小时的观察期，每年每个 ED 的就诊量为 100,000 次（N=160），对 2 所社区 ED 进行了 203 个 2 小时的观察期，每年就诊量分别为 19,000 次和 21,000 次（N=43）。报告的数据每 2 小时呈现中位数和最小值-最大值。急诊医师将大部分时间用于间接护理活动（学术 64 分钟，29 至 91 分钟；社区 55 分钟，25 至 95 分钟），其次是直接护理活动（学术 36 分钟，6 至 79 分钟；社区 41 分钟，5 至 60 分钟）。个人时间因地点类型而异（学术 6 分钟，0 至 66 分钟；社区 13 分钟，0 至 69 分钟）。所有医生同时照顾多名患者，中位数患者数大于 5（学术 7 例，2 至 16 例；社区 6 例，2 至 12 例）。
急诊医师将大部分时间用于间接患者护理活动。他们经常被打断，与大量人员互动。他们同时照顾大量患者，同时承担多项患者护理职责。在学术环境中工作的医生被打断的频率是其社区同行的两倍。
