Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Emerg Med J. 2018 May;35(5):317-322. doi: 10.1136/emermed-2017-207194. Epub 2018 Mar 15.
Emergency physician productivity, often defined as new patients evaluated per hour, is essential to planning clinical operations. Prior research in this area considered this a static quantity; however, our group's study of resident physicians demonstrated significant decreases in hourly productivity throughout shifts. We now examine attending physicians' productivity to determine if it is also dynamic.
This is a retrospective cohort study, conducted from 2014 to 2016 across three community hospitals in the north-eastern USA, with different schedules and coverage. Timestamps of all patient encounters were automatically logged by the sites' electronic health record. Generalised estimating equations were constructed to predict productivity in terms of new patients per shift hour.
207 169 patients were seen by 64 physicians over 2 years, comprising 9822 physician shifts. Physicians saw an average of 15.0 (SD 4.7), 20.9 (SD 6.4) and 13.2 (SD 3.8) patients per shift at the three sites, with 2.97 (SD 0.22), 2.95 (SD 0.24) and 2.17 (SD 0.09) in the first hour. Across all sites, physicians saw significantly fewer new patients after the first hour, with more gradual decreases subsequently. Additional patient arrivals were associated with greater productivity; however, this attenuates substantially late in the shift. The presence of other physicians was also associated with slightly decreased productivity.
Physician productivity over a single shift follows a predictable pattern that decreases significantly on an hourly basis, even if there are new patients to be seen. Estimating productivity as a simple average substantially underestimates physicians' capacity early in a shift and overestimates it later. This pattern of productivity should be factored into hospitals' staffing plans, with shifts aligned to start with the greatest volumes of patient arrivals.
急诊医师的生产力，通常以每小时评估的新患者数量来定义，对规划临床运营至关重要。该领域的先前研究认为这是一个静态数量；然而，我们小组对住院医师的研究表明，整个轮班期间每小时的生产力都会显着下降。现在我们检查主治医生的生产力，以确定它是否也是动态的。
这是一项回顾性队列研究，于 2014 年至 2016 年在美国东北部的三家社区医院进行，这些医院的日程安排和覆盖范围不同。所有患者就诊的时间戳均由站点的电子病历自动记录。构建了广义估计方程，以预测每班次小时的新患者数量的生产力。
2 年来，64 名医生共诊治了 207169 名患者，共涉及 9822 次医生轮班。医生在三个地点的平均每班分别诊治了 15.0（SD 4.7）、20.9（SD 6.4）和 13.2（SD 3.8）名患者，第一个小时分别有 2.97（SD 0.22）、2.95（SD 0.24）和 2.17（SD 0.09）名患者。在所有地点，医生在第一个小时后看到的新患者明显减少，随后减少速度逐渐放缓。更多的患者到达与更高的生产力相关；然而，这种情况在轮班后期会大大减弱。其他医生的存在也与生产力略有下降相关。
即使有新患者需要就诊，单个班次的医生生产力也会遵循可预测的模式，每小时显着下降。将生产力估计为简单平均值会大大低估医生在轮班前半段的能力，并在轮班后期高估医生的能力。这种生产力模式应纳入医院的人员配备计划，使班次与患者到达量最大的时间相匹配。
