Doctors' working conditions in emergency care units in Germany: a real-time assessment

Background and objectives As interest in doctors' work in Germany has increased over the last few years, this study determines how doctors spend their work time in emergency departments. The study also provides information on patient load and working conditions in emergency units. Methods and material An observational time-and-motion study was carried out at three emergency departments. A single investigator followed emergency doctors and recorded the time spent on various work activities. Job activities were classified into 12 different main categories, including direct or indirect patient care. Results The data showed that doctors in emergency departments had to work overtime (M=09.17 h). They performed more than 80 tasks per day and were forced to handle multitasking situations. Indirect patient care and administrative duties were the main tasks doctors spent time on during the day. Direct patient care and contact represented only a small proportion of work time. Conclusion Doctors working in emergency care units have to deal with highly unpredictable workloads and overtime work, and simultaneously should also care for patients and interact with a large number of different persons during each work shift. The findings of this study are useful in efforts to improve emergency medical care and doctors' working conditions.

[1]  K. Shojania,et al.  Understanding medical error and improving patient safety in the inpatient setting. , 2002, The Medical clinics of North America.

[2]  C. Armstrong,et al.  Junior doctors' extended work hours and the effects on their performance: the Irish case. , 2011, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[3]  Anthony L Back,et al.  The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. , 2005, Archives of internal medicine.

[4]  Ian M Paul,et al.  Evaluating Communication Between Pediatric Primary Care Physicians and Hospitalists , 2011, Clinical pediatrics.

[5]  Xin Li,et al.  The impact of cost sharing of prescription drug expenditures on health care utilization by the elderly: own- and cross-price elasticities. , 2007, Health policy.

[6]  James Lind,et al.  Emergency care workload units: A novel tool to compare emergency department activity , 2010, Emergency medicine Australasia : EMA.

[7]  N. Shapiro,et al.  The effects of clinical workload on teaching in the emergency department. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[8]  C. Chisholm,et al.  A task analysis of emergency physician activities in academic and community settings. , 2011, Annals of emergency medicine.

[9]  David A Groneberg,et al.  Cardiologists' workflow in small to medium-sized German hospitals: an observational work analysis , 2011, Journal of cardiovascular medicine.

[10]  J. Wasem,et al.  Demand, selection and patient outcomes in German acute care hospitals. , 2012, Health economics.

[11]  J. Szaflarski,et al.  Clinical Work Intensity Among Physician Specialties: How Might We Assess It?: What Do We Find? , 2011, Medical care.

[12]  Dominik Aronsky,et al.  Shifting toward balance: measuring the distribution of workload among emergency physician teams. , 2007, Annals of emergency medicine.

[13]  B. Klapp,et al.  Real time analysis of psychiatrists’ workflow in German hospitals , 2011, Nordic journal of psychiatry.

[14]  Katherine S. Jones,et al.  Interruptions experienced by registered nurses working in the emergency department. , 2011, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[15]  S. Davis,et al.  Emergency department workload increase: dependence on primary care? , 2010, The Journal of emergency medicine.

[16]  Kevin J O'Leary,et al.  How hospitalists spend their time: insights on efficiency and safety. , 2006, Journal of hospital medicine.

[17]  Occupational Burnout levels in Emergency Medicine–a stage 2 nationwide study and analysis , 2010, Journal of medicine and life.

[18]  Dominik Aronsky,et al.  Tracking Workload in the Emergency Department , 2006, Hum. Factors.

[19]  E. Cayir,et al.  Burnout status of interns and associated factors. , 2010, Cahiers de sociologie et de demographie medicales.

[20]  P. Sprivulis.  Pilot study of metropolitan emergency department workload complexity. , 2004, Emergency medicine Australasia : EMA.

[21]  D. Schwappach,et al.  Working conditions and Work-Family Conflict in German hospital physicians: psychosocial and organisational predictors and consequences , 2008, BMC public health.

[22]  B. Klapp,et al.  Observation and analysis of junior OB/GYNs’ workflow in German hospitals , 2010, Archives of Gynecology and Obstetrics.

[23]  B. Klapp,et al.  Analysis and evaluation of geriatricians' working routines in German hospitals , 2012, Geriatrics & gerontology international.

[24]  Vimla L. Patel,et al.  Towards a hybrid method to categorize interruptions and activities in healthcare , 2007, Int. J. Medical Informatics.

[25]  D. Au,et al.  Patient-clinician communication about end-of-life care topics: is anyone talking to patients with chronic obstructive pulmonary disease? , 2011, Journal of palliative medicine.

[26]  B. Klapp,et al.  Pediatricians’ working conditions in German hospitals: a real-time task analysis , 2010, European Journal of Pediatrics.

[27]  Mph Rainu Kaushal MD,et al.  Healthcare Consumers’ Attitudes Towards Physician and Personal Use of Health Information Exchange , 2011, Journal of General Internal Medicine.

[28]  N. Girard.  Multitasking: how much is too much? , 2007, AORN journal.

[29]  B. Klapp,et al.  Cancer care and residents' working hours in oncology and hematology departments: an observational real-time study in German hospitals. , 2011, Japanese journal of clinical oncology.

[30]  O. Aasland,et al.  Work Hours and Self rated Health of Hospital Doctors in Norway and Germany. A comparative study on national samples , 2011, BMC health services research.

[31]  J. Nelson.  Why patients visit emergency units rather than use primary care services. , 2011, Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association.

[32]  K. Janus,et al.  German physicians "on strike"--shedding light on the roots of physician dissatisfaction. , 2007, Health policy.

[33]  David A. Groneberg,et al.  General and visceral surgery practice in German hospitals: a real-time work analysis on surgeons’ work flow , 2009, Langenbeck's Archives of Surgery.

[34]  Thomas D. Bentley,et al.  Specificity of computerized physician order entry has a significant effect on the efficiency of workflow for critically ill patients , 2005, Critical care medicine.

[35]  Johanna I Westbrook,et al.  All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time , 2008, The Medical journal of Australia.

[36]  Sonia Jain,et al.  A real-time assessment of work stress in physicians and nurses. , 2009, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[37]  F. Griffiths,et al.  Verbal and non-verbal behavior of doctors and patients in primary care consultations - how this relates to patient enablement. , 2012, Patient education and counseling.

[38]  T W Whitley,et al.  Factors associated with stress among emergency medicine residents. , 1989, Annals of emergency medicine.

[39]  W H Cordell,et al.  Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices. , 2001, Annals of emergency medicine.

[40]  S. Mache,et al.  [Always out of breath? An analysis of a doctor's tasks in pneumology]. , 2009, Pneumologie.

[41]  W H Cordell,et al.  How do physicians and nurses spend their time in the emergency department? , 1998, Annals of emergency medicine.

[42]  D. Baker,et al.  Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. , 2007, JAMA.

[43]  Vimla L. Patel,et al.  The multitasking clinician: Decision-making and cognitive demand during and after team handoffs in emergency care , 2007, Int. J. Medical Informatics.

[44]  N. Okamoto,et al.  Working hours, occupational stress and depression among physicians. , 2011, Occupational medicine.

[45]  H Eyrolle,et al.  The effects of interruptions in work activity: field and laboratory results. , 2000, Applied ergonomics.

[46]  R. Wachter,et al.  Primary care physician attitudes regarding communication with hospitalists. , 2001, The American journal of medicine.

[47]  B. Klapp,et al.  An observational real-time study to analyze junior physicians' working hours in the field of gastroenterology. , 2009, Zeitschrift fur Gastroenterologie.

[48]  B. Leake,et al.  Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. , 1985, JAMA.

[49]  R. Grol,et al.  Work satisfaction of general practitioners and the quality of patient care. , 1985, Family practice.