Measuring emergency department workload perception using electronic medical record measures of patient volume and acuity

Background: Workload in the Emergency Department (ED) fluctuates and there is no established model for measurement of clinician-level ED workload.Objective: Measure perceived ED workload and assess the relationship between perceived workload and objective measures of workload from the electronic medical record (EMR).Methods: This study was conducted at a tertiary care, academic ED from 7/1/2020–4/13/2021. Attending workload perceptions were collected using a five-point scale in 3 care areas with variable acuity. We collected 8 EMR measures thought to correlate with perceived workload. EMR values were compared across areas of the department using ANOVA and correlated with attending workload ratings using linear regression.Results: We collected 315 unique workload ratings which were normally distributed. For the entire department, there was a weak positive correlation between reported workload perception and mean percentage of inpatient admissions (r=0.23, p<0.001), ICU admissions (r=0.2, p<0.001), patient arrivals per shift (r=0.14, p=0.017), critical care billed visits (r=0.22, p<0.001), CPR code activations (r=0.2, p<0.001), and Level 5 visits (r=0.13, p=0.02). There was weak negative correlation for ED discharges, r=-0.23, p<0.001. Several correlations were stronger in individual care areas, including percent admissions in the lowest-acuity area (r=.43, p=.033) and patient arrivals in the highest acuity area (r=.44, p<.01). No significant correlation was found in any area for observation admissions or trauma activations.Conclusion: In this study, EMR measures of workload were not closely correlated with ED attending physician workload perception. Future study should examine additional factors contributing to physician workload outside of the EMR.