Quantifying and Visualizing Emergency Physician Workflow: Results of an Observational Time-Motion Study

BackgroundEmergency physicians face considerable workflow challenges in the emergency department (ED) due to unpredictable work environments, frequent interruptions, and mounting documentation requirements. Excessive time away from direct patient care is increasingly viewed as detrimental to care quality, communication, and patient safety. ObjectiveThis study aimed to quantify and visualize how emergency physicians allocate their time during ED shifts, particularly time spent on the computer. MethodsThis observational time-motion pilot study was conducted in a high-volume, urban ED. We used a specialized application to continuously track physician activities including computer use, direct patient care, communication, and all other tasks carried out on shift. Electronic health record (EHR) event log data were queried to estimatephysicians computer use after their scheduled shift. The main outcome was the proportion of time spent on each activity. The primary measure was total minutes of computer use (during and after shift) per scheduled hour of clinical work. ResultsWe observed 20 emergency physicians for one 8-9 hour clinical shift each, generating over 150.0 hours of real-time observation data quantifying physicians ED workflow. Physicians spent a median 34.1% of their shift using the computer and 26.9% with patients. Other activities included verbal communication with staff (15.9%), phone use (9.5%), miscellaneous tasks (5.5%), personal time (3.9%), electrocardiogram review (0.7%), and procedures (0.4%). EHR log analysis showed that physicians spent an additional median 1.3h (IQR 0.5-2.6) using the computer after their scheduled shifts, for a combined 29.8 minutes (IQR 25.6-38.5) on the computer per scheduled hour of their ED shift. ConclusionsEmergency physicians spent more than one-third of their ED shift working on the computer, which was more time than they spent with patients. They also spent 1-2 hours using the computer after their scheduled shift. These findings demonstrate the need for strategies to reduce unnecessary computer use during and after clinical shifts to enhance workflow efficiency and improve patient care.