title: Dedication increases productivity: an analysis of the implementation of a dedicated medical team in the emergency department.
abstract: BACKGROUND
  In several European countries, emergency departments (EDs) now employ a dedicated team of full-time emergency medicine (EM) physicians, with a distinct leadership and bed-side emergency training, in all similar to other hospital departments. In Portugal, however, there are still two very different models for staffing EDs: a classic model, where EDs are mostly staffed with young inexperienced physicians from different medical departments who take turns in the ED in 12-h shifts and a dedicated model, recently implemented in some hospitals, where the ED is staffed by a team of doctors with specific medical competencies in emergency medicine that work full-time in the ED. Our study assesses the effect of an intervention in a large academic hospital ED in Portugal in 2002, and it is the first to test the hypothesis that implementing a dedicated team of doctors with EM expertise increases the productivity and reduces costs in the ED, maintaining the quality of care provided to patients.
  
  
  METHODS
  A pre-post design was used for comparing the change on the organisational model of delivering care in our medical ED. All emergency medical admissions were tracked in 2002 (classic model with 12-h shift in the ED) and 2005/2006 (dedicated team with full-time EM physicians), and productivity, costs with medical human resources and quality of care measures were compared.
  
  
  RESULTS
  We found that medical productivity (number of patients treated per hour of medical work) increased dramatically after the creation of the dedicated team (X2KW= 31.135; N = 36; p < 0.001) and costs with ED medical work reduced both in regular hours and overtime. Moreover, hospitalisation rates decreased and the length of stay in the ED increased significantly after the creation of the dedicated team.
  
  
  CONCLUSIONS
  Implementing a dedicated team of doctors increased the medical productivity and reduced costs in our ED. Our findings have straightforward implication for Portuguese policymakers aiming at reducing hospital costs while coping with increased ED demand.
authors.affiliation: Faculty of Medicine, University of Porto, Porto, Portugal. pedrosaldanharamos@live.com.pt.|Medical Director Office, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. pedrosaldanharamos@live.com.pt.
authors.forename: Pedro
authors.identifier: http://orcid.org/0000-0002-6825-6577
authors.initials: P
authors.lastname: Ramos
authors.affiliation: Faculty of Medicine, University of Porto, Porto, Portugal.|Autonomous Management Unit of Emergency and Intensive Care Medicine of Centro Hospitalar São João, Porto, Portugal.
authors.forename: José Artur
authors.initials: JA
authors.lastname: Paiva
keywords: Doctors; Healthcare team; Hospitals; Organisation efficiency