Description of the effect of patient flow, junior doctor supervision and pandemic preparation on the ability of emergency physicians to provide direct patient care

Abstract

Objective: A pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance; and (2) to identify the effect of system and process factors on productivity. Methods: A retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. Results: A total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56-4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P < 0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% (95% CI: 1.1-3.4, P < 0.001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4-15.6, P < 0.001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. Conclusions: Emergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic?: An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician's ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add?: This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician's ability to complete primary consults. What are the implications for practitioners?: When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.