title: Shifting toward balance: measuring the distribution of workload among emergency physician teams.
abstract: OBJECTIVE
  The objective of this investigation is to determine time-dependent workload patterns for emergency department (ED) physician teams across work shifts. A secondary aim was to demonstrate how ED demand patterns and the timing of shift changes influence the balance of workload among a physician team.
  
  
  METHODS
  Operational measurements of an adult ED were collected from a clinical information system to characterize physician workload patterns during all current work shifts. Plots of patient load versus time were developed for each physician shift, in which patient load was defined as the number of patients a physician simultaneously managed at a point in time. Patient-load curves for each shift were superimposed during 24 hours to display how patient load was distributed among a team of physicians.
  
  
  RESULTS
  Resident shift changes during daily peak occupancy periods caused patient load imbalances so that residents on a particular shift consistently managed a disproportionate number of patients (mean 9.4 patients; 95% confidence interval [CI] 6.7 to 12.1 patients) compared with other residents on duty (mean 3.4 patients; 95% CI 2.1 to 4.7 patients).
  
  
  CONCLUSIONS
  Physician patient load patterns and ED demand patterns should be taken into consideration when physician shift times are scheduled so that patient load may be balanced among a team. Real-time monitoring of physician patient load may reduce stress and prevent physicians from exceeding their safe capacity for workload.
authors.affiliation: Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, TN, USA. scott.r.levin@vanderbilt.edu
authors.forename: Scott
authors.initials: S
authors.lastname: Levin
authors.forename: Dominik
authors.initials: D
authors.lastname: Aronsky
authors.forename: Robin
authors.initials: R
authors.lastname: Hemphill
authors.forename: Jin
authors.initials: J
authors.lastname: Han
authors.forename: Jason
authors.initials: J
authors.lastname: Slagle
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: France
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006801:Humans; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D019370:Observation; D010346:Patient Care Management / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D013647:Task Performance and Analysis; D014481:United States; D000078329:Workforce; D016526:Workload