How Do Physicians and Nurses Spend Their Time in the Emergency Department?

Study objectives: To determine how emergency physicians and nurses spend their time on emergency department activities. Methods: An observational time-and-motion study was performed at a 36-bed ED with annual census of 84,000 in a central city teaching hospital sponsoring an emergency medicine residency program. Participants were emergency medicine faculty physicians, second- and third-year emergency medicine resident physicians, and emergency nurses. A single investigator followed individual health care providers for 180-minute periods and recorded time spent on various activities, type and number of activities, and distance walked. Activities were categorized as direct patient care (eg, history and physical examination), indirect patient care (eg, charting), or non- patient care (eg, break time). Results: On average, subjects spent 32% of their time on direct patient care, 47% on indirect patient care, and 21% on non-patient care. Faculty physicians, residents, and emergency nurses differed in the time spent on these three categories of activities. Although the overall time spent on direct patient care activities was not significantly different, emergency nurses spent more of their time (2.2%) providing comfort measures (a subcategory of direct patient care) than did faculty physicians (.05%) or resident physicians (.03%). Emergency nurses spent 38.9% of their time performing indirect care, whereas faculty physicians spent 51.3% and resident physicians 53.7%. Resident physicians spent more time charting than did faculty physicians or emergency nurses (21.4%, 11.9%, and 6.9%, respectively). Emergency nurses spent more time on personal activities than did physicians, and faculty physicians walked less than either emergency nurses or resident physicians. Conclusion: Emergency physicians and nurses spent almost half of their time on indirect patient care. Physicians spent significantly more time on indirect patient care activities and significantly less time on personal activities than did nurses. [Hollingsworth JC, Chisholm CD, Giles BK, Cordell WH, Nelson DR: How do physicians and nurses spend their time in the emergency department? Ann Emerg Med January 1998;31:87-91.]