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Disposition Time Early vs Late in Your Shift – Is There a Difference?

January 6, 2022

Written by Eriny Hanna

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Providers at the end of the shift were faster to disposition patients by 38 minutes compared to the beginning of their shift.

Why does this matter?
Time-to-disposition is key for emergency department throughput. With recent increases in patient volumes and boarding in the ED, it’s important to understand provider behaviors to best improve department flow and mitigate bottlenecks.

What’s the hold up?
This study evaluated 31,869 patient encounters in the early group (hours 1-4) and 18,933 in the late group (hours 5-10). The median time-to-disposition was shorter for every hour into the shift. Median time-to-disposition for the early group was 3.25 hours (interquartile rank 1.90, 5.04) compared to 2.62 hours (interquartile range 1.51, 4.31) for the late group. Providers took a median difference of 38 minutes less to disposition during the second half of their shift. A linear mixed model analysis that controlled for multiple confounding variables confirmed the findings.

The authors explain that early in the shift, providers are usually focused on picking up more patients, which leads to a high patient census and more flow-interrupting tasks. Alternatively, the end of the shift is perceived as a “stopping point,” so providers may have a goal of dispositioning patients to avoid signing them out. This workflow can exacerbate bottlenecks, such as assigning hospital beds to admitted patients. The study has limitations being a single academic center study. There were unassessed confounding variables, for example hourly census, that could impact time-to-disposition. But it’s a good reminder to think about which patient to disposition before moving to see a new stable patient.

Analysis of time-to-disposition intervals during early and late parts of an emergency department shift. Am J Emerg Med. 2021 Dec;50:477-480. doi: 10.1016/j.ajem.2021.09.002. Epub 2021 Sep 4.

What are your thoughts?