Characterizing patient care in hospital emergency departments

Abstract

The purpose of this study is to characterize the early stage (i.e., until first prescriber order) of patient care in emergency departments (EDs) by focusing on the temporal sequence of activities by multiple roles. A hundred and eight patient care episodes in three EDs were observed and modeled as patient-oriented workflows. Capturing individual episodes allowed us to account for cooperative work in EDs. Data analysis revealed a high level of variability across patient care episodes. We also identified six patterns differentiated primarily by whether the prescriber is a physician or midlevel clinician. Secondary differentiators included whether the patient arrived in the ED as walk-in or via ambulance, and in which ED the patient care occurred. The high level of workflow variability reported in this study should be recognized in the design of ED work systems. Moreover, work interventions should not limit EDs’ capacity to handle sequential variability in patient care.

Keywords:

• emergency departments
• workflow
• activity
• role
• sequence

Acknowledgements

The authors thank the Brennan Health Systems Lab at University of Wisconsin-Madison and the participants of the EDLinking project for its support. The project is funded by Center for Medicare and Medicaid Services, with evaluation subcontracted to the University of Wisconsin-Madison (Grant number 0705WITRA1). Authors also thank Dr. Sharon Johnson for her comments on the early drafts of the manuscript.