Planning and designing a patient-centered measure for physician workload in the pediatric emergency department

Health Research BC is providing matching funds for this project, which is funded by the Canadian Institutes of Health Research’s Winter 2023 ICS Planning and Dissemination Grant – Supporting & Strengthening the Health Workforce stream.

Measuring the workload of pediatric emergency physicians is essential to help determine workforce needs, allocate resources to ensure timely care, assure patient safety, and diminish burnout. There are currently no widely accepted ways to measure pediatric emergency physician workload. Currently, staffing decisions are based on gestalt, availability, or average productivity measures that do not account for individual patient resource needs. This can lead to discrepancies in workload that affect both safety and efficiency and contribute to increased wait times and physician burnout. At a high level, a valid and reliable physician workload measure would help government agencies, universities, and hospital administrators identify and plan physician workforce needs and guide strategies for the training, recruitment, retention and allocation of the physician workforce. On a day-to-day and clinical level, this measure would allow for monitoring the workload of individual physicians in the emergency department (ED) and eventually, using machine learning (artificial intelligence) and linked healthcare data, could predict the workload for each patient that walks into the ED in order to assure a balanced, safe, and efficient assignment of patients. This grant will allow Canadian experts in pediatric emergency medicine, health services research, digital health, patient experience, and indigenous health to share knowledge and perspectives and establish a framework to derive and test a pediatric emergency physician workload measure in future planned research collaborations.

Dr. Quynh Doan is a clinician scientist in pediatric emergency medicine and health services research at the University of British Columbia. The multi-disciplinary team conducting this project has expertise in health services research, decision support systems, bioinformatics, implementation of research software projects, and clinical decision support.

End of Award Update – July 2024

Results

With our funding, we were able to gather local community member partners along with pediatric emergency medicine and digital health experts from across Canada for a productive three-day workshop. Over the course of the three days, we were able to develop a comprehensive list of patient care components that pediatric emergency physicians perform, as well as patient and environmental factors (modifiers) that can influence physician workload. We were also able to generate preliminary workload scores for each care component. This work completes phase one of our project, and we will now gather an even larger number of pediatric emergency physicians to verify the preliminary scores and assign a weight to each modifier in our second group of gatherings across the country.

Impact

Our team has been working on a manuscript that will soon be submitted for publication describing how we developed the SWAMPED score. We have also presented the project to clinicians across Canada and the Pacific Northwest; it received a very positive response at both presentations and audience members were interested in collaborating in future work. We will work with our collaborators to write our next grant together to do the later work for this project.

Additionally, having pediatric emergency medicine experts and community member partners share their experiences with giving and receiving care in the pediatric emergency department, respectively, allowed for each group to better understand the other in this context, while also contributing to the goals of our workshop. This will also have impacts on our future work as it has helped to strengthen collaborations that are key to continued progress and success.

Potential Influence

This novel physician workload measure will allow for future work using machine learning with linked healthcare data, developing systems that can forecast workload associated with individual pediatric emergency department patients and facilitate the most efficient and safe assignment of workload to providers. This will help anticipate future workforce requirements and guide resource allocation appropriately, while also improving patient care and reducing physician burnout.

Next Steps

We will now work on the validation phase of the SWAMPED project. This phase will see participating physicians complete online surveys to score different aspects of their workload based on the list of specific care components and modifiers developed during our initial workshop. The validation of SWAMPED will move us one step forward towards implementation, improving patient care, reducing physician burnout, and increasing the sustainability of the pediatric emergency medicine workforce.