Time Motion Analysis of Emergency Physician Workload in Urgent Care Settings
Introduction: The Predictors of Workload in the Emergency Room (POWER) study, published in 2009 using data from 2003, examined the workload of emergency physicians using the Canadian Triage and Acuity Scale (CTAS) as a surrogate marker. Many hospitals use a case-mix formula incorporating annual cens...
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eScholarship Publishing, University of California
2025-07-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/82d6v0zv |
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| author | Scott Odorizzi Jessica Hogan Sabrain Idris Loraina Marzano Veronique Rowley Max Yan Yuxin Zhang Jeffrey J. Perry |
| author_facet | Scott Odorizzi Jessica Hogan Sabrain Idris Loraina Marzano Veronique Rowley Max Yan Yuxin Zhang Jeffrey J. Perry |
| author_sort | Scott Odorizzi |
| collection | DOAJ |
| description | Introduction: The Predictors of Workload in the Emergency Room (POWER) study, published in 2009 using data from 2003, examined the workload of emergency physicians using the Canadian Triage and Acuity Scale (CTAS) as a surrogate marker. Many hospitals use a case-mix formula incorporating annual census and POWER’s study data to determine staffing levels. However, significant changes in emergency medicine have occurred since its publication, including the implementation of electronic health record systems, increased patient complexity, real-time dictation software, and human health resource challenges due to the COVID-19 pandemic. In this study we aimed to quantify the time required to perform tasks during the care of ambulatory emergency department (ED) patients. Our secondary objective was to stratify these times based on CTAS and clinician factors. Methods: We conducted a prospective observational time-motion study in the urgent care section of a tertiary-care, academic ED with 90,000 visits annually, 70% of which are ambulatory. Research assistants shadowed physicians on two 8-hour shifts daily (8 am-12 am) from July 12–August 14, 2022, tracking the time taken by physicians to perform tasks. We calculated aggregate task times per patient. Results: We observed 1,204 patient encounters over 65 shifts by 37 unique physicians. The mean treatment time was 21.6 minutes (95% confidence interval [CI] 19.9 – 23.3) for ambulatory CTAS 2 patients; 22.5 minutes (95% CI 21.2 – 23.6) for CTAS 3 patients; 19.7 minutes (95% CI 17.9 – 21.6) for CTAS 4 patients; and 17.4 minutes (95% CI 14.9 – 19.9) for CTAS 5 patients. Compared to the previous 2003 POWER study data, CTAS 4 and 5 patient assessment times took 31% and 58% longer, respectively. Total assessment time by CTAS was statistically significant only comparing CTAS 5 patients to all others ( P = .02). Physicians who dictated their charts spent 34% less time (2.1 minutes per patient) charting than those who typed them. Conclusion: The average time to see an ambulatory ED patient was 21.7 minutes. Low-acuity urgent care patients take longer to assess now than 20 years ago. The CTAS alone is a poor marker of workload for ambulatory patients, necessitating a reassessment of staffing and compensation formulas. |
| format | Article |
| id | doaj-art-1106fdc5bc6749a5b5ef29ce7ba8149b |
| institution | Kabale University |
| issn | 1936-900X 1936-9018 |
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| publishDate | 2025-07-01 |
| publisher | eScholarship Publishing, University of California |
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| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-1106fdc5bc6749a5b5ef29ce7ba8149b2025-08-20T04:02:41ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182025-07-0126480480910.5811/westjem.41536wjem-26-804Time Motion Analysis of Emergency Physician Workload in Urgent Care SettingsScott Odorizzi0Jessica Hogan1Sabrain Idris2Loraina Marzano3Veronique Rowley4Max Yan5Yuxin Zhang6Jeffrey J. Perry7University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, CanadaThe Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, CanadaThe Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, CanadaThe Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, CanadaThe Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, CanadaThe Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, CanadaThe Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, CanadaUniversity of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, CanadaIntroduction: The Predictors of Workload in the Emergency Room (POWER) study, published in 2009 using data from 2003, examined the workload of emergency physicians using the Canadian Triage and Acuity Scale (CTAS) as a surrogate marker. Many hospitals use a case-mix formula incorporating annual census and POWER’s study data to determine staffing levels. However, significant changes in emergency medicine have occurred since its publication, including the implementation of electronic health record systems, increased patient complexity, real-time dictation software, and human health resource challenges due to the COVID-19 pandemic. In this study we aimed to quantify the time required to perform tasks during the care of ambulatory emergency department (ED) patients. Our secondary objective was to stratify these times based on CTAS and clinician factors. Methods: We conducted a prospective observational time-motion study in the urgent care section of a tertiary-care, academic ED with 90,000 visits annually, 70% of which are ambulatory. Research assistants shadowed physicians on two 8-hour shifts daily (8 am-12 am) from July 12–August 14, 2022, tracking the time taken by physicians to perform tasks. We calculated aggregate task times per patient. Results: We observed 1,204 patient encounters over 65 shifts by 37 unique physicians. The mean treatment time was 21.6 minutes (95% confidence interval [CI] 19.9 – 23.3) for ambulatory CTAS 2 patients; 22.5 minutes (95% CI 21.2 – 23.6) for CTAS 3 patients; 19.7 minutes (95% CI 17.9 – 21.6) for CTAS 4 patients; and 17.4 minutes (95% CI 14.9 – 19.9) for CTAS 5 patients. Compared to the previous 2003 POWER study data, CTAS 4 and 5 patient assessment times took 31% and 58% longer, respectively. Total assessment time by CTAS was statistically significant only comparing CTAS 5 patients to all others ( P = .02). Physicians who dictated their charts spent 34% less time (2.1 minutes per patient) charting than those who typed them. Conclusion: The average time to see an ambulatory ED patient was 21.7 minutes. Low-acuity urgent care patients take longer to assess now than 20 years ago. The CTAS alone is a poor marker of workload for ambulatory patients, necessitating a reassessment of staffing and compensation formulas.https://escholarship.org/uc/item/82d6v0zv |
| spellingShingle | Scott Odorizzi Jessica Hogan Sabrain Idris Loraina Marzano Veronique Rowley Max Yan Yuxin Zhang Jeffrey J. Perry Time Motion Analysis of Emergency Physician Workload in Urgent Care Settings Western Journal of Emergency Medicine |
| title | Time Motion Analysis of Emergency Physician Workload in Urgent Care Settings |
| title_full | Time Motion Analysis of Emergency Physician Workload in Urgent Care Settings |
| title_fullStr | Time Motion Analysis of Emergency Physician Workload in Urgent Care Settings |
| title_full_unstemmed | Time Motion Analysis of Emergency Physician Workload in Urgent Care Settings |
| title_short | Time Motion Analysis of Emergency Physician Workload in Urgent Care Settings |
| title_sort | time motion analysis of emergency physician workload in urgent care settings |
| url | https://escholarship.org/uc/item/82d6v0zv |
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