Date of Award
8-2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Industrial Engineering
Committee Chair/Advisor
Sudeep Hegde
Committee Member
Jackie Cha
Committee Member
Ronald Pirrallo
Committee Member
Kevin Taaffe
Abstract
Recent increases in emergency physician (EP) workload have been identified as contributors to increased EP burnout, increased staff attrition, decreased patient safety, and increased patient admission rates. Patient handoffs have been extensively researched as critical points in patient care, with existing research primarily focusing on communication errors and interventions designed to standardize handoff communication protocols.
While end of shift handoffs in hospital emergency departments (EDs) intuitively represent a transfer of patient caseload from an outgoing EP to an incoming EP, there is a fundamental lack of literature examining how such handoffs contribute to EP workload, and a similar lack of validated metrics to measure such workload in ED settings. Validated metrics of EP workload for usage during patient handoffs are necessary to accurately measure the effects of interventions seeking to reduce EP workload and its relevant effects on staff well-being and quality of care. Given the lack of validated metrics in existing literature, there is an evident need for validated EP workload metrics designed for measuring the effects of patient handoffs on EP workload. This dissertation research aims to directly address this scarcity, by identifying a metric of EP workload that is construct validated, contextually validated as a measure of the effects of end of shift patient handoffs on EP workload, and feasible for reliable usage by non-clinical researchers in hospital EDs.
A systematic review of existing literature identified combinations of ED metrics, physiological measures of experienced mental workload, and the NASA TLX questionnaire as construct-validated measures of EP workload. Observations and interviews pertaining to EP workflows identified the state of patients’ disposition as a contributor to EP cognitive load and led to the derivation of the disposition mapping for physician sign-out (DMAPS) as a measure of task load that is also representative of this cognitive load. The relative disposition-based caseload was shown to significantly correlate with EPs’ anticipated perceived mental workload as measured by the NASA TLX questionnaire, and DMAPS was identified as the best predictor of the contributions of patient handoffs to EP mental workload as measured by both measures of EP heart rate variability and EPs’ anticipated mental workload as measured by the NASA TLX questionnaire. Based on these results, DMAPS was found to be a construct-validated measure of EP work-based workload that also represents aspects of EP mental workload. DMAPS was then further validated for reliable usage by non-clinical researchers, demonstrating its’ applicability for regular usage by diverse populations in hospital EDs.
This research provides a novel measure of EP workload during end of shift patient handoffs that can be used to evaluate handoff and policy interventions and provide a basis for future measures of ED staff workload that can be used to address EP burnout, staff attrition, and decreased patient safety.
Recommended Citation
Foster, Steven, "Identification and Validation of a Measurement of Emergency Physician Workload During End of Shift Patient Handoffs" (2024). All Dissertations. 3702.
https://open.clemson.edu/all_dissertations/3702
Author ORCID Identifier
https://orcid.org/0009-0006-4358-6306