title: Efficiency in the emergency department - A complex relationship between throughput rates and staff perceptions.
abstract: BACKGROUND
  It is well known that emergency departments (EDs) suffer from crowding and throughput challenges, which make the ED a challenging workplace. However, the interplay between the throughput of patients and how staff experience work is seldom studied. The aim of this study was to investigate whether staff experience of work (efficiency, work-related efforts and rewards, and quantity and quality of work) differs between days with low and high patient throughput rates.
  
  
  METHODS
  Throughput times were collected from electronic medical records and staff (n=252 individuals, mainly nurses) ratings in daily questionnaires over a total of six weeks. Days were grouped into low and high throughput rate days for the orthopedic, surgical and internal medicine sections, respectively, and staff ratings were compared.
  
  
  RESULTS
  On days with low throughput rates, employees rated their efficiency, effort, reward and quantity of work significantly higher than on days with high throughput rates. There was no difference in perceived quality of work.
  
  
  CONCLUSIONS
  There is a complex relationship between ED throughput rates and staff perceptions of efficiency and efforts/rewards with work, suggesting that whereas low throughput may be troublesome from a patient and organizational perspective, working conditions may still be perceived as more favorable.
authors: Procome, Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Sweden. Electronic address: Ulrica.schwarz@ki.se.
authors: Ulrica
authors: U
authors: von Thiele Schwarz
authors: Procome, Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Sweden; Center for Epidemiology and Community Medicine, Unit for Implementation, Stockholm County Council, Stockholm, Sweden.
authors: Henna
authors: H
authors: Hasson
authors: Department of Medical Sciences, Uppsala University, Sweden; School of Nursing, University of Adelaide, Australia; Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Sweden.
authors: Åsa
authors: Å
authors: Muntlin Athlin
mesh_terms: D001291:Attitude of Health Personnel; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D009726:Nurses / Q000523:psychology*; D010465:Perception; D010820:Physicians / Q000523:psychology; D057566:Self Report; D011795:Surveys and Questionnaires; D013548:Sweden; D017132:Workplace / Q000523:psychology / Q000592:standards
keywords: Efficiency; Emergency department; Multitasking; Registered nurse; Work environment; Workflow; Working conditions; throughput rates