Hostname: page-component-6766d58669-bp2c4 Total loading time: 0 Render date: 2026-05-17T02:50:45.618Z Has data issue: false hasContentIssue false
  • English
  • Français

Physician workload and the Canadian Emergency Department Triage and Acuity Scale: the Predictors of Workload in the Emergency Room (POWER) Study

Published online by Cambridge University Press:  21 May 2015

Jonathan F. Dreyer ,
Shelley L. McLeod ,
Chris K. Anderson ,
Michael W. Carter  and
Gregory S. Zaric
Jonathan F. Dreyer*
Affiliation:
Division of Emergency Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.
Shelley L. McLeod
Affiliation:
Division of Emergency Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.
Chris K. Anderson
Affiliation:
School of Hotel Administration, Cornell University, New York, NY Richard Ivey School of Business, University of Western Ontario, London, Ont.
Michael W. Carter
Affiliation:
Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ont.
Gregory S. Zaric
Affiliation:
Richard Ivey School of Business, University of Western Ontario, London, Ont.
*
Rm. E1-100, Victoria Hospital, 800 Commissioners Rd. E., London ON N6A 5W9; jonathan.dreyer@lhsc.on.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the 'Save PDF' action button.
Introduction:

The Canadian Emergency Department Triage and Acuity Scale (CTAS) is a 5-level triage tool used to determine the priority by which patients should be treated in Canadian emergency departments (EDs). To determine emergency physician (EP) workload and staffing needs, many hospitals in Ontario use a case-mix formula based solely on patient volume at each triage level. The purpose of our study was to describe the distribution of EP time by activity during a shift in order to estimate the amount of time required by an EP to assess and treat patients in each triage category and to determine the variability in the distribution of CTAS scoring between hospital sites.

Methods:

Research assistants directly observed EPs for 592 shifts and electronically recorded their activities on a moment-by-moment basis. The duration of all activities associated with a given patient were summed to derive a directly observed estimate of the amount of EP time required to treat the patient.

Results:

We observed treatment times for 11 716 patients in 11 hospital-based EDs. The mean time for physicians to treat patients was 73.6 minutes (95% confidence interval [CI] 63.6–83.7) for CTAS level 1, 38.9 minutes (95% CI 36.0–41.8) for CTAS-2, 26.3 minutes (95% CI 25.4–27.2) for CTAS-3, 15.0 minutes (95% CI 14.6–15.4) for CTAS-4 and 10.9 minutes (95% CI 10.1–11.6) for CTAS-5. Physician time related to patient care activities accounted for 84.2% of physicians' ED shifts.

Conclusion:

In our study, EPs had very limited downtime. There was significant variability in the distribution of CTAS scores between sites and also marked variation in EP time related to each triage category. This brings into question the appropriateness of using CTAS alone to determine physician staffing levels in EDs.

Keywords

emergency departmentworkloadacuityhuman resourcesremunerationstaffing

Information

Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 4 , July 2009 , pp. 321 - 329
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

References

REFERENCES

1. Canadian Association of Emergency Physicians. Implementation guidelines for the CanadianED triage and acuity scale (CTAS). Ottawa (ON): The Association; 2005. Available: http://www.caep.ca/template.asp?id=98758372CC0F45FB826FFF4 9812638DD (accessed 2009 Jun 3).Google Scholar
2. Canadian Institute of Health Information. Understanding emergency department wait times:How long do people spend in emergency departments in Ontario? Ottawa (ON): The Institute; 2007.Google Scholar
3. Beveridge, R. CAEP issues. The Canadian triage and Acuity Scale: a new and critical element in health care reform. Canadian Association of Emergency Physicians. J Emerg Med 1998;16:507–11.Google Scholar
4. Murray, MJ. The Canadian triage and acuity scale: a Canadian perspective on emergency department triage. Emerg Med Fremantle) 2003;15:6–10.CrossRefGoogle Scholar
5. Bond, MJ, Erwich-Nijhout, MA, Phillips, DG, et al. Urgency, disposition and age groups: a case-mix model for emergency medicine. Emerg Med 1998;10:103–10.CrossRefGoogle Scholar
6. Erwich-Nijhout, MA, Bond, MJ, Phillips, DG, et al. The identification of costs associated with emergency department attendances. Emerg Med 1997;9:181–8.CrossRefGoogle Scholar
7. Graff, LG, Radford, MJ. Formula for emergency physician staffing. Am J Emerg Med 1990;8:194–9.CrossRefGoogle ScholarPubMed
8. Hollingsworth, JC, Chisholm, CD, Giles, BK, et al. How do physicians and nurses spend their time inthe emergency department? Ann Emerg Med 1998;31:87–91.CrossRefGoogle Scholar
9. Innes, GD, Stenstrom, R, Grafstein, E, et al. Prospective time study derivation of emergency physician workload predictors. CJEM 2005;7:299–308.CrossRefGoogle ScholarPubMed
10. Agouridakis, P, Hatzakis, K, Chatzimichali, K, et al. Workload and case-mix in a Greek emergency department. Eur J Emerg Med 2004;11:81–5.CrossRefGoogle Scholar
11. Graff, LG, Wolf, S, Dinwoodie, R, et al. Emergency physician workload: a time study. Ann Emerg Med 1993;22:1156–63.CrossRefGoogle ScholarPubMed
12. London, D. Survival models and their estimation. 2nd ed. Winsted (CT): ACTEX Publications; 1988.Google Scholar
13. Atack, L, Rankin, JA, Then, KL. Effectiveness of a 6-week online course in the Canadian Triage and Acuity Scalefor emergency nurses. J Emerg Nurs 2005;31:436–41.CrossRefGoogle Scholar
14. Beveridge, R, Ducharme, J, Janes, L, et al. Reliability of the Canadian Emergency Department Triage and Acuity Scale: inter-rater agreement. Ann Emerg Med 1999;34:155–9.CrossRefGoogle Scholar
15. Goransson, KE, Ehnfors, M, Fonteyn, ME, et al. Emergency department triage: is there a link between nurses’ personal characteristics and accuracy in triage decisions? Accid Emerg Nurs 2006;14:83–8.CrossRefGoogle Scholar
16. Manos, D, Petrie, DA, Beveridge, RC, et al. Inter-observer agreement using the Canadian Emergency Department Triage and Acuity scale. CJEM 2002;4:16–22.CrossRefGoogle ScholarPubMed
17. Grafstein, E, Innes, G, Westman, J, et al. Inter-rater reliability of a computerized presenting-complaint-linked triage system in an urban emergency department. CJEM 2003;5:323–9.Google Scholar
18. Millar, KR, Tough, S, Stewart, B, et al. Estimating physician workload in the pediatric emergency department. CJEM 2008;10:257.Google Scholar