Start Strong, Finish Weak - Attending Shift Productivity

Written by Clay Smith

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Attending physician productivity peaked at the beginning of the shift, starting with about 3 new patients in the first hour at these three facilities and decreased as the shift progressed.  Assuming a simple, uniform average over the shift won't work for staffing.

Why does this matter?
When making clinical staffing decisions, it is important to match staffing with patient volume.  Prior study has shown that residents see more patients per hour at the beginning than at the end of the shift.  What are the patterns of attending physician productivity?

Start strong, finish weak
This was a retrospective study of attending physician productivity (new patients per hour) at three community EDs in the northeastern US.  They found over a two-year period that attending physicians saw 15, 21, and 13 patients per shift on average at each location.  They saw, on average, 3, 3, and 2 per hour for the first hour of the shift and it went downhill from there, with volume decreasing per hour as the shift progressed.  Interestingly, it was a more gradual decline over time than in the prior resident productivity study.  They also were less likely to pick up new arrivals later in the shift.  Having other physicians present also decreased patients per hour.  Many would argue this is not a bad way to structure a shift.  It can be galling for a fellow physician to pick up new patients right up to the last minute, collect the RVUs, sign them out immediately, and leave all the real work to the oncoming attending.  This has implications for staffing, as we want to match productivity with peak volume.  If administrators use a simple average and assume uniform productivity for each hour of the shift, this will result in increased wait times.  Rather, planning for this with overlapping shifts during peak-volume times can mitigate this effect.

Source
Modelling attending physician productivity in the emergency department: a multicentre study.  Emerg Med J. 2018 May;35(5):317-322. doi: 10.1136/emermed-2017-207194. Epub 2018 Mar 15.

Reviewed by Thomas Davis

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