Familiarity, Load, and Patient Pick-Up: The Positive and Negative Effects of Group Composition on Physician Behavior in the Emergency Department

Abstract

Background: Patient demand for emergency medical services continues to rise from all-time highs. ED physicians generally respond to this rising demand by increasing their level of multitasking. Aim: What leads ED physicians to select which patients, and how many patients, they will treat? Queuing models frequently assume individual servers operate independently of other servers. In contrast, we consider how familiarity between peers affects a physician’s chosen multitasking level through patient selection, otherwise known as “patient pick-up. Methods: Using data from multiple EDs, we quantify the effect of familiarity on multitasking empirically, show this effect occurs due to changes in pick-up behavior, and explore the combined impact of familiarity and multitasking on other ED outcomes. Results: Among ED physicians, greater average familiarity leads to observed multitasking, an increase in patient pick-up rate, and shorter patient wait time -- all with no identifiable, negative impact to patient processing time or length of stay. Moreover, these effects intensify at the end of a physician’s shift and for patients in severe condition. Conclusion: Within more familiar groups, physicians appear willing to exert more effort. This study explicates how these benefits materialize and illustrates why researchers must consider server familiarity moving forward.