Productivity, efficiency, and overall performance comparisons between attendings working solo versus attendings working with residents staffing models in an emergency department: A Large-Scale Retrospective Observational Study

Robinson, Richard D.; Dib, Sasha; Mclarty, Daisha; Shaikh, Sajid; Cheeti, Radhika; Zhou, Yuan; Ghasemi, Yasaman; Rahman, M. Mostafizur; Schrader, Chet D.; Wang, Hao

doi:10.1371/journal.pone.0228719

Cited by 7 publications

(6 citation statements)

References 20 publications

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“…Taking into account aspects related to working with residents, greater effectiveness was observed in group work than in individual work. ( 38 ). In a study by Kang et al In the United States, emergency departments are constantly under pressure to improve operational efficiency and quality in order to obtain financial benefit and maintain a positive reputation.…”

Section: Discussionmentioning

confidence: 99%

Work climate in emergency health services during COVID-19 pandemic—An international multicenter study

Kosydar-Bochenek

Krupa

Religa

et al. 2022

Front. Public Health

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IntroductionA good working climate increases the chances of adequate care. The employees of Emergency in Hospitals are particularly exposed to work-related stress. Support from management is very important in order to avoid stressful situations and conflicts that are not conducive to good work organization. The aim of the study was to assess the work climate of Emergency Health Services during COVID-19 Pandemic using the Abridged Version of the Work Climate Scale in Emergency Health Services.DesignA prospective descriptive international study was conducted.MethodsThe 24-item Abridged Version of the Work Climate Scale in Emergency Health Services was used for the study. The questionnaire was posted on the internet portal of scientific societies. In the study participated 217 women (74.5%) and 74 men (25.4%). The age of the respondents ranged from 23 to 60 years (SD = 8.62). Among the re-spondents, the largest group were Emergency technicians (85.57%), followed by nurses (9.62%), doctors (2.75%) and Service assistants (2.06%). The study was conducted in 14 countries.ResultsThe study of the climate at work shows that countries have different priorities at work, but not all of them. By answering the research questions one by one, we can say that the average climate score at work was 33.41 min 27.0 and max 36.0 (SD = 1.52).ConclusionThe working climate depends on many factors such as interpersonal relationships, remuneration or the will to achieve the same selector. In the absence of any of the elements, a proper working climate is not possible.

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Section: Discussionmentioning

confidence: 99%

Work climate in emergency health services during COVID-19 pandemic—An international multicenter study

Kosydar-Bochenek

Krupa

Religa

et al. 2022

Front. Public Health

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“…Working alone and working with residents are 2 strategies used by attending physicians in teaching hospitals and the literature reflects mixed results regarding efficiency and productivity for these strategies. 52,53 Using the SEIPS framework, several factors can be identified that influence attending physician documentation: resident completion, patient acuity, EMR usability and functionality, and physical layout. 54 This study also identified strategies used by attending physicians to complete documentation: multitasking, documenting in different locations, and dictation.…”

Section: Discussionmentioning

confidence: 99%

Doctors documenting: an ethnographic and informatics approach to understanding attending physician documentation in the pediatric emergency department

Fouquet

Fitzmaurice

Chan

et al. 2020

Journal of the American Medical Informatics Association

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Objective The pediatric emergency department is a highly complex and evolving environment. Despite the fact that physicians spend a majority of their time on documentation, little research has examined the role of documentation in provider workflow. The aim of this study is to examine the task of attending physician documentation workflow using a mixed-methods approach including focused ethnography, informatics, and the Systems Engineering Initiative for Patient Safety (SEIPS) model as a theoretical framework. Materials and Methods In a 2-part study, we conducted a hierarchical task analysis of patient flow, followed by a survey of documenting ED providers. The second phase of the study included focused ethnographic observations of ED attendings which included measuring interruptions, time and motion, documentation locations, and qualitative field notes. This was followed by analysis of documentation data from the electronic medical record system. Results Overall attending physicians reported low ratings of documentation satisfaction; satisfaction after each shift was associated with busyness and resident completion. Documentation occurred primarily in the provider workrooms, however strategies such as bedside documentation, dictation, and multitasking with residents were observed. Residents interrupted attendings more often but also completed more documentation actions in the electronic medical record. Discussion Our findings demonstrate that complex work processes such as documentation, cannot be measured with 1 single data point or statistical analysis but rather a combination of data gathered from observations, surveys, comments, and thematic analyses. Conclusion Utilizing a sociotechnical systems framework and a mixed-methods approach, this study provides a holistic picture of documentation workflow. This approach provides a valuable foundation not only for researchers approaching complex healthcare systems but also for hospitals who are considering implementing large health information technology projects.

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“… 15 , 24 , 25 In emergency department settings, residents have been associated with some positive and negative impacts: increased attending productivity (number of patients seen), decreased efficiency (time to see patients), as well as greater adeptness using the EHR. 26 , 27 Yet to our knowledge, no studies have examined how these contributions interplay directly with attending EHR use.…”

Section: Introductionmentioning

confidence: 99%

Otolaryngology resident clinic participation and attending electronic health record efficiency—A user activity logs study

Wandell

Giliberto

2021

Laryngoscope Investig Oto

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Objectives: In an era of increasing electronic health record (EHR) use monitoring and optimization, this study aims to quantify resident contributions and measure the effect of otolaryngology resident coverage in clinic on attending otolaryngologist EHR usage. Methods:In one academic otolaryngology department, monthly attending provider efficiency profile metrics, data collected by the EHR vendor (Epic Systems Corporation) between January and June 2019 were accessed. Using weekly resident schedules, resident coverage of attending outpatient clinics was categorized by junior (post-graduate year [PGY] 1-3) and senior levels (PGY-4 through fellows) and correlated with attending EHR metrics using linear mixed effect models.Results: Thirteen attending otolaryngologists on average spent 58.8 minutes per day interacting with the EHR. In modeling, one day of trainee clinic coverage was associated with a 22 minutes reduction (95% CI [À37, À6]) in total daily attending EHR time and a 12 minutes reduction (95% CI [À21, À3]) in per day note time (P < .05). When stratifying by trainee level, senior coverage was associated with significantly reduced total daily time in EHR, per day time in clinical review, notes, and orders, as well as per appointment time in notes and clinical review (P < .05). Junior coverage was only associated with reduced per day note time (P < .05).Conclusions: Increasing resident clinic coverage was inversely related to attending time spent in the EHR and writing notes. Resident contributions to EHR workflows and hospital system productivity should continue to be studied and considered in EHR use measurement studies.

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Productivity, efficiency, and overall performance comparisons between attendings working solo versus attendings working with residents staffing models in an emergency department: A Large-Scale Retrospective Observational Study

Cited by 7 publications

References 20 publications

Work climate in emergency health services during COVID-19 pandemic—An international multicenter study

Work climate in emergency health services during COVID-19 pandemic—An international multicenter study

Doctors documenting: an ethnographic and informatics approach to understanding attending physician documentation in the pediatric emergency department

Otolaryngology resident clinic participation and attending electronic health record efficiency—A user activity logs study

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