Description of the impact of flow, junior doctor supervision, and pandemic preparation on the ability of Emergency Physicians to provide direct patient care

Andy Lim, Namankit Gupta, Alvin Lim, Wei Hong, Katie Walker

Research output: Contribution to journalArticleResearchpeer-review


Objective: A pilot study to (1) describe the ability of Emergency Physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance, and (2) to identify the impact of system and process factors on productivity. Methods: A retrospective cross-sectional description of shifts worked between 1st to 29th February 2020, whilst physicians were carrying out their usual supervision, flow and problem-solving duties as well as undertaking additional COVID-19 preparation. Impact of supervisory load, years of Australian registration, and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. Results: A total of 188 shifts were analyzed. Productivity was 4.07 patients/9.5-hour shift [95% CI 3.56, 4.58] or 0.43 patients/hr, representing a 48.5% reduction from previously published data (p<0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% [95% CI: 1.1-3.4, p<0.001] decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% [95% CI: 5.4-15.6, p<0.001] decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. Conclusions: Emergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID19 preparations reduced their ability to see their own patients by half.
Original languageEnglish
Number of pages7
JournalAustralian Health Review
Publication statusAccepted/In press - 31 Aug 2020


  • Health services administration & management
  • Workforce
  • Clinical services
  • pandemic
  • Performance and evaluation

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