How productive emergency physicians work: a qualitative interview study of clinical workflow in the emergency department

BACKGROUND: Operational efficiency in the emergency department (ED) is crucial for minimizing patient wait times, preventing overcrowding, and optimizing resource utilization. Although systemic inefficiencies in ED operations have been extensively studied, the understanding of individual physician-level work practices that support high productivity is limited. This study aimed to explore how productive emergency physicians structure their work in order to provide insights into physician-level practices that may support clinical workflow and overall departmental efficiency. METHODS: This study employed a thematic analysis informed by Braun and Clarke's reflexive approach to analyze semi-structured interviews with eight high-throughput emergency physicians at Stockholm South General Hospital (Södersjukhuset) in Stockholm, one of Sweden's largest emergency hospitals, between March and May 2021. Five predefined topic areas (prioritization, communication, examination, laboratory and imaging modalities and medical record management), guided data collection and the initial organization of the dataset, after which themes were developed inductively through an iterative and collaborative analytic process. RESULTS: Thematic analysis developed six themes characterizing how productive emergency physicians structured their workflow: initial situational awareness, parallel progression, cognitive offloading, anticipatory communication, selective resource utilization and pragmatic responsiveness. CONCLUSION: This study provides insights into work practices that may enhance productivity in emergency medicine, with the potential to be reinforced through targeted training. Integrating these approaches into physician education could help reduce patient wait times, prevent overcrowding, and optimize resource utilization, thereby improving overall workflow. Further research is needed to explore their broader implications for clinical decision-making, healthcare efficiency, and patient safety.