Stenson Bryan A, Antkowiak Peter S, Chiu David T, Sanchez Leon D, Joseph Joshua W
Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts.
Brigham and Women's Faulkner Hospital, Department of Emergency Medicine, Boston, Massachusetts.
West J Emerg Med. 2025 Mar;26(2):295-300. doi: 10.5811/westjem.21298.
Advance practice clinicians (APC) play significant roles in academic and community emergency departments (ED). In attendings and residents, prior research demonstrated that productivity is dynamic and changes throughout a shift in a predictable way. However, this has not been studied in APCs. The primary outcome of this study was to model productivity for APCs in community EDs to determine whether it changes during a shift similar to the way it does for attendings and residents.
This was a retrospective, observational analysis of 10-hour APC shifts at two suburban hospitals, worked by 14 total individuals. We examined the number of patients seen per hour of the shift by experienced APCs who see all acuity and staff all patients with an attending. We used a generalized estimating equation to construct the model of hour-by-hour productivity change.
We analyzed 862 shifts over one year across two sites, with three shift start times. Site 1 10 am-8 pm saw an average of 13.31 (95% confidence interval [CI] 13.02-13.63) patients per shift; Site 2 8 am-6 pm saw an average of 12.64 (95% CI 12.32-13.06) patients per shift; Site 2 4 pm-2 am saw an average of 12.53 (95% CI 12.04-12.82) patients per shift. Across all sites and shifts, hour 1 saw the highest number of patients. Each subsequent hour was associated with a small, statistically significant decrease over the previous hours. This was most pronounced in the shift's last two hours.
The productivity of APCs demonstrates a similar pattern of hourly declines observed in both resident and attending physicians. This corroborates prior findings that patients per hour is a dynamic variable, decreasing throughout a shift. This provides further external validity to prior research to include both APCs and community EDs. These departments must take this phenomenon into account, as it has scheduling and operational consequences.
高级实践临床医生（APC）在学术性和社区急诊科（ED）中发挥着重要作用。在主治医师和住院医师中，先前的研究表明，工作效率是动态的，并且在一个班次中会以可预测的方式变化。然而，这尚未在APC中进行研究。本研究的主要结果是为社区急诊科的APC建立工作效率模型，以确定其在一个班次中的变化是否与主治医师和住院医师的情况类似。
这是一项对两家郊区医院10小时的APC班次进行的回顾性观察分析，共有14人参与。我们检查了经验丰富的APC在每个班次小时内诊治的患者数量，这些APC负责诊治所有病情严重程度的患者，并在主治医师的指导下为所有患者提供服务。我们使用广义估计方程构建每小时工作效率变化的模型。
我们分析了两个地点一年中的862个班次，有三个班次开始时间。地点1上午10点至晚上8点的班次平均每班诊治13.31名患者（95%置信区间[CI] 13.02 - 13.63）；地点2上午8点至下午6点的班次平均每班诊治12.6名患者（95% CI 12.32 - 13.06）；地点2下午4点至凌晨2点的班次平均每班诊治12.53名患者（95% CI 12.04 - 12.82）。在所有地点和班次中，第1小时诊治的患者数量最多。随后的每个小时与前几个小时相比都有小幅的、具有统计学意义的下降。这在班次的最后两小时最为明显。
APC的工作效率呈现出与住院医师和主治医师类似的每小时下降模式。这证实了先前的研究结果，即每小时诊治的患者数量是一个动态变量，在一个班次中会减少。这为先前包括APC和社区急诊科的研究提供了进一步的外部有效性。这些科室必须考虑到这一现象，因为它会对排班和运营产生影响。
