Table 1 Key features for the two type of models of medical staffing of EDs in Portugal

The ED is handled by doctors from different medical specialties (primarily junior doctors in training)

There is a team of doctors with formal training in emergency medicine (primarily consultants/senior doctors)

Part-time—12 to 18 h/week in the ED

Full-time—40 h/week in the ED

The ED director has no direct leadership responsibilities over the medical staff (i.e. each medical doctor answers to his department head)

The ED direct has a formal leadership role over the medical team

Inexistent ED recruiting policies (staffing is dependent on other departments’ needs)

There is an active recruitment based on doctors’ vocation for the ED work

The ED’s strategy and leadership structure is unclear to most doctors that occasionally work in the ED, and the medical staff is usually not aware of key performance indicators in the ED

The ED is a hospital department on its own, with a leadership structure, a clear strategy aligned to the hospital’s mission and vision and a regular monitoring and discussion of key performance indicators in the ED

Scarce training in the ED (e.g. advanced life support, trauma patient, …)

Formal training courses in the ED on a regular basis

Doctors who occasionally visit the ED for patient care are less committed to quality improvement measures, case discussion, clinical audit activities, …

Doctors from the team, who continuously work in the ED, are more committed to quality improvement measures, process engineering, case discussion, clinical audit activities, team-building initiatives, …