Emergency department physicians' distribution of time in the fast paced-workflow-a novel time-motion study of drug-related activities.

Background In the emergency department physicians are forced to distribute their time to ensure that all admitted patients receive appropriate emergency care. Previous studies have raised concerns about medication discrepancies in patient's drug lists at admission to the emergency department. Thus, it is important to study how emergency department physicians distribute their time, to highlight where workflow redesign can be needed.Aim to quantify how emergency department physicians distribute their time between various task categories, with particular focus on drug-related tasks.Method Direct observation, time-motion study of emergency department physicians at Diakonhjemmet Hospital, Oslo, Norway. Physicians' activities were categorized in discrete categories and data were collected with the validated method of Work Observation Method By Activity Timing between October 2018 to January 2019. Bootstrap analysis determined 95% confidence intervals for proportions and interruption rates.Results During the observation time of 91.4 h, 31 emergency department physicians were observed. In total, physicians spent majority of their time gathering information (36.5%), communicating (26.3%), and documenting (24.2%). Further, physicians spent 17.8% (95% CI 16.8%, 19.3%) of their time on drug-related tasks. On average, physicians spent 7.8 min (95% CI 7.2, 8.6) per hour to obtain and document patients' drug lists.Conclusion Emergency department physicians are required to conduct numerous essential tasks and distributes a minor proportion of their time on drug-related tasks. More efficient information flow regarding drugs should be facilitated at transitions of care. The presence of healthcare personnel dedicated to obtaining drug lists in the emergency department should be considered.

A case-control study of asthma and ovarian cancer.

Epidemiologic studies have found inverse associations between allergy and the development of certain tumors. The authors sought to determine if there was an association between asthma and ovarian cancer. A case-control study was conducted using Florida hospital data (year 2001). Discharge diagnoses were coded using the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification). Cases were 1,582 women whose principal discharge diagnosis was a malignant neoplasm of the ovary. Two control series were used: 4,744 women whose principal diagnosis was an upper limb bone fracture, and 21,830 women whose principal diagnosis was an acute myocardial infarction. Odds ratios (ORs) adjusted for age, race-ethnicity, Medicaid status, obesity, and smoking were calculated. Cases were 30% less likely than fracture control to be asthmatics (adjusted OR = 0.70, 95% confidence interval [CI]: 0.49-0.99, p = .04). Similarly, cases when compared to acute myocardial infarction controls were significantly less likely to have asthma (adjusted OR = 0.62, 95% CI: 0.45-0.87, p = .005). The results of this statewide exploratory study suggest that individuals with asthma may have a lower risk of developing ovarian cancer than nonasthmatics.