One hundred tasks an hour: An observational study of emergency department consultant activities

Objective: To determine work activity patterns undertaken by ED consultants. Methods: A single observer time-motion study of consultants rostered to clinical shifts: primarily administrative (Duty) or clinical (Resuscitation). Direct observation of 130 h was undertaken using purpose developed time-stamping software. Primary outcome was task number and time spent in predetermined categories of activity. Comparisons occurred by role delineation, sex, weekday and time of day. Results: For each observed hour consultants performed 101 discrete tasks. A high proportion was spent multitasking; 77 min of overlapping activity in each hour of observation. Consultants spent 42% of each hour on communication, 35% on direct clinical care and 24% on computer use; only 9% was spent on non-clinical tasks. Consultants spent little time (0.6%) accessing e-resources. Duty consultants undertook more tasks than Resuscitation consultants, 111 versus 90, and more time was spent on communication (47% vs 35%) and computer use (32% vs 15%) with less on clinical care (29% vs 43%). Female consultants undertook 119 tasks per hour compared with 93 for male consultants; more time was spent on communication (51% vs 38%) and computer use (28% vs 22%). No difference in activity occurred by time of day or weekday. Conclusion: ED consultants have very high hourly task rates dominated by communication and clinical activities and frequently multitask. The activity is relatively constant throughout the week but is influenced by sex and role delineation. Appreciation of activity distribution might allow informed interventions to realign the workload or divert tasks to supporting resources.