Associations between physician work practices and productivity in emergency departments: a systematic review

Emergency department operation depends on system-level efficiency and individual physician productivity. Although organizational interventions are well described, evidence on modifiable, clinician-level work practices remains limited. This systematic review aimed to identify and synthesize evidence on individual work practices associated with higher levels of physician productivity in emergency departments and to assess their potential transferability through training. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in PROSPERO. Eligible studies were primary studies involving physicians working in adult or pediatric emergency departments and examining budget-neutral, modifiable work practices attributable to individual physicians' behavior. Studies were required to report a quantifiable productivity outcome per unit time, such as patients per hour or relative value units per hour. Heterogeneity in methods and outcomes precluded meta-analysis. Findings were synthesized narratively and supplemented by an inductive process applied to extracted study findings to categorize and integrate heterogeneous evidence. Ten studies met the inclusion criteria: three direct observational studies, six retrospective observational studies, and one interventional study, all conducted in the United States. Two domains of productive work practices clearly emerged in the literature: controlled multitasking, which showed a nonlinear association with productivity, and team communication, which showed a consistent positive association with productivity. The only interventional study reported no measurable improvement in productivity after a lecture on evidence-based work practices. Controlled multitasking and team communication practices showed the strongest associations with productivity across studies. However, the evidence remains limited, underscoring the need for further investigation.