OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

https://emj.bmj.com/content/emermed/35/5/317.full.pdf

Modelling attending physician productivity in the emergency department: a multicentre study

Emergency department (ED) overcrowding and long patient wait times have been studied extensively in the literature due to its relevance. We propose a novel approach to assign physicians to shifts such that ED wait times are reduced without adding new physicians. In particular, we extend the physician rostering problem by including the heterogeneity between emergency physicians with regard to their productivity levels (measured as patient-per-hour rate) and by including the stochastic nature of patient arrivals and physician productivity. We formulate the physician rostering problem as a two-stage stochastic program and solve it with a sample average approximation and the L-shaped method. To formulate the problem, we perform a data analysis to investigate the major drivers of physician productivity levels using patient visit data from our partner ED, and find that it is sufficient to only consider individual physicians and the shift hour in which they are scheduled to provide emergency care. In particular, the workload and occupancy levels in the ED have a significant impact on physician productivity levels but the magnitude of this impact is minor. A simulation study calibrated using real data shows that the new scheduling from our formulation can reduce patient wait times by as much as 20%, compared to the current scheduling at our study ED. We also demonstrate how to incorporate physician preference in scheduling through physician clustering based on their productivity levels. Our simulation results show that EDs can receive almost full benefit even when the number of clusters is fairly small.

Scheduling of Physicians with Time-Varying Productivity Levels in Emergency Departments

To investigate the effects of the dramatic reduction in presentations to Italian Emergency Departments (EDs) on the main indicators of ED performance during the SARS-CoV-2 pandemic. From February to June 2020 we retrospectively measured the number of daily presentations normalized for the number of emergency physicians on duty (presentations/physician ratio), door-to-physician and door-to-final disposition (length-of-stay) times of seven EDs in the central area of Tuscany. Using the multivariate regression analysis we investigated the relationship between the aforesaid variables and patient-level (triage codes, age, admissions) or hospital-level factors (number of physician on duty, working surface area, academic vs. community hospital). We analyzed data from 105,271 patients. Over ten consecutive 14-day periods, the number of presentations dropped from 18,239 to 6132 (− 67%) and the proportion of patients visited in less than 60 min rose from 56 to 86%. The proportion of patients with a length-of-stay under 4 h decreased from 59 to 52%. The presentations/physician ratio was inversely related to the proportion of patients with a door-to-physician time under 60 min (slope − 2.91, 95% CI − 4.23 to − 1.59, R2 = 0.39). The proportion of patients with high-priority codes but not the presentations/physician ratio, was inversely related to the proportion of patients with a length-of-stay under 4 h (slope − 0.40, 95% CI − 0.24 to − 0.27, R2 = 0.36). The variability of door-to-physician time and global length-of-stay are predicted by different factors. For appropriate benchmarking among EDs, the use of performance indicators should consider specific, hospital-level and patient-level factors.

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The presentations/physician ratio predicts door-to-physician time but not global length of stay in the emergency department: an Italian multicenter study during the SARS-CoV-2 pandemic.

A. Yang

Papers

403: Impact of Emergency Medicine Residents on Attending Physician Productivity: A Case-Control Study

220: Emergency Physician Productivity: A Comparison of 8-hour versus 12-hour Shifts