How hospitalists spend their time: Insights on efficiency and safety

Abstract

BACKGROUNDDespite the dramatic growth of hospitalists, no studies have evaluated the type and frequency of activities that hospitalists perform. To evaluate the types and frequency of activities that hospitalists perform during routine work, we conducted a time‐motion study of hospitalist physicians at our institution.DESIGNA research assistant shadowed hospitalist physicians for 3‐ to 5‐hour periods. Observation periods were distributed in order to sample all parts of a typical day of a hospitalist, including both admitting and nonadmitting periods. Activities were recorded on a standardized data collection form in 1‐minute intervals. Incoming pages were recorded as well.RESULTSTen hospitalists were shadowed by a single research assistant for a total of 4467 minutes. Hospitalists spent 18% of their time on direct patient care, 69% on indirect patient care, 4% on personal activities, and 3% each on professional development, education, and travel. Communication accounted for 24% of the total minutes. Multitasking, performing more than one activity at the same time, was done 21% of the time. Hospitalists received an average of 3.4 ± 1.5 pages per hour.CONCLUSIONSHospitalists spent most of their time on indirect patient care activities and relatively little time on direct patient care. Hospitalists spent a large amount of time on communication, underscoring the need for hospitalists to have outstanding communication skills and systems that support efficient communication. Multitasking and paging interruptions were common. The inherent distraction caused by interruptions and multitasking is a potential contributor to medical error and warrants further study. Journal of Hospital Medicine 2006;1:88–93. © 2006 Society of Hospital Medicine.

Defining and measuring the effort needed for inpatient medicine work

“…Several time-motion studies have been performed to document the work done by residents [8][9][10][11][12][13][14][15] and hospitalists. 16,17 Although our study did not assess the time spent on each task, the distribution of tasks across categories is consistent with these time-motion studies, which show that the amount of time spent in direct patient care is a small fraction of the amount of time spent in the hospital, 12 and that work such as interprofessional communication 10 and documentation 16 consume the majority of time. This project allowed us to consider the effort required for inpatient internal medicine work on a more granular level than has been described previously.…”

Prioritizing Paperwork Over Patient Care: Why Can't We Do Both?

“…1 For every 3 minutes spent face-to-face with a patient, 1 minute is needed for clerical tasks, with charting comprising the brunt of this work. 3,[12][13][14] These data are corroborated by a meta-analysis from 2010 that reported only 23% of a hospitalist's time is spent directly interacting with patients. 15 One would think that advances in technology 16 might reduce time committed to clinical documentation due to streamlining of data through an electronic health record (EHR); however, residents and attending physicians may be spending up to 3 times longer with the EHR than when they were using paper charting.…”

The use of smartphones for clinical communication on internal medicine wards

“…1,2 Poor communication is known to be a source of inefficiency and errors within healthcare. [3][4][5][6] The major issues with communication include the frequent use of interruptive communication mechanisms and the difficulty of knowing who to contact.…”