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Table 2 The match of information processing and the situation on weekends

From: Exploring reasons for the weekend effect in a hospital emergency department: an information processing perspective

Uncertainty sources Capacities Situation on weekends
Task complexity Admission of patients with diverse symptoms, treatment needs, and treatment stages • Matrix structure supported by contracts and matrix managers
• Triage system
• Self-contained subunits managed by emergency physicians
• Morning conference
• Different roles
• Less effective morning conference, because the conference is managed by a physician from another department
• One single emergency physician covers both A1 and A2
Different numbers of patients • Flexible self-contained subunits
• Matrix structure
• External agreements about calling physicians from other departments when their skills are needed
• Less flexibility of resources between self-contained subunits, because only two units are in operation and one is “outsourced”
Patients with a mix of conditions • Emergency physicians and nurses with emergency care skills
• Flow master to coordinate
• The temporary physicians have limited skills, e.g., skills in surgery and coordination
Lack of information about the influx of patients • Hospital visitation • Less time to use the information provided by the hospital visitation
Lack of knowledge about the patients' conditions and which competences are needed • Triage system
• Formalized rules and SOP guide less experienced physicians
• Supervision
• Less supervision of the less experienced physicians because of the emergency physician’s limited time
(and skills if a temporary physician is on duty)
Task inter-dependence High degree of co-solving of tasks, employees rely on one another to perform their individual tasks • Flow master and coordinating nurses coordinate overall tasks
• Staff employed in the same department treat most of the patients
• Cetrea and EPR facilitate communication
• Triage system and formalized rules to coordinate the subtasks
• The emergency physician has too much to do, leaving a lot of coordination to the coordinating nurse
• Less use of Cetrea due to the “outsourcing” of tasks
Inter-unit task inter-dependence Dependence on extensive collaboration with other departments at the hospital • Matrix structure supported by contracts and matrix managers • More tasks are solved by physicians from other departments on weekends → increased uncertainty, requiring more coordination
• Focus is changing from the emergency care process to a focus on specialty