An attending physician float shift for the improvement of physician productivity in a crowded emergency department

BACKGROUND:Patients backlogged in the emergency department(ED) waiting for an inpatient bed(boarders) continue to require the attention of ED physicians,exacerbating crowding in the ED.To address this problem,we added a "float shift" to our winter schedule solely to care for boarders.We sought to quantify the effect of this float shift,hypothesizing greater physician productivity.METHODS:We performed a retrospective observational study in our community hospital ED,measuring the number of new patients seen in each 10-hour shift in the presence or absence of a float shift physician.We calculated the number of new patients seen per shift for each of the 7 daily shifts,during February(float shift scheduled) and May(float shift unscheduled) of 2008.We then compared the mean number of patients seen per shift in February with May.RESULTS:Total monthly patient volume was 6 656 for February and 6 775 for May,with the mean daily census being 230 and 219 patients,respectively.The number of new patients seen during each shift was greater in February than in May,with a mean increase of 1.1 patients per shift(with the float shift).Surveying participants about intervention effectiveness showed 92%of residents,but only 65%of attending physicians,in favor of maintaining the float shift.CONCLUSION:The presence of a "float shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED,despite the presence of longer throughput times and increased time on diversion.