Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians

Weigl, Matthias; Müller, Andreas; Zupanc, Andrea; Angerer, Peter

doi:10.1186/1472-6963-9-110

Cited by 81 publications

(91 citation statements)

References 41 publications

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“…We examined tasks and documentation use during the encounter and interviewed participants about their preferences. Our finding that a large percent of time in an ED clinical encounter is spent on documentation activities (65%) is similar to those of other studies in which documentation activities ranged from 23% to 59% of the encounter [7,12,14]. Our results also suggest a considerable amount of documentation is performed while the physician is performing another activity in parallel.…”

Section: Discussionsupporting

confidence: 90%

“…Efficiency and physician time are critical, particularly in EDs [9,10]. Emergency physicians often multi-task and frequently transition between activities quickly and unexpectedly while simultaneously handling multiple patients and frequent interruptions [11,12]. In addition, ED patient acuities and patient volumes vary, influencing the ways in which physicians perform routine tasks [13].…”

mentioning

confidence: 99%

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Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

Neri¹,

Redden²,

Poole³

et al. 2015

Appl Clin Inform

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SummaryObjective: To understand emergency department (ED) physicians' use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules. Methods: We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes. Results: Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources. Conclusion: We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving integration of clinical data. These findings should be tested quantitatively in a larger, representative study. Research Article P.M. Neri et al.: Physicians' Perceptions of Electronic Documentation and WorkflowFor personal or educational use only. No other uses without permission. All rights reserved. BackgroundElectronic clinical documentation serves multiple purposes including communication, billing, maintenance of a legal record, and serves as a tool for synthesis and medical decision making. Electronic Health Record (EHR) incentive programs in the United States designed to stimulate health information technology (HIT) adoption require hospitals and providers to show they use the EHR "meaningfully" and meet certain objectives in order to receive incentive payments. The second stage of the meaningful use program recognizes the importance of electronic documentation by including it as a menu objective to fulfill program requirements [1]. In response to these policies and incentives, emergency departments (EDs)...

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

Neri¹,

Redden²,

Poole³

et al. 2015

Appl Clin Inform

View full text Add to dashboard Cite

show abstract

“…[1][2][3]5,6 Similarly, we found that physicians spent 5.3 minutes per patient-about 13% of an 8-hour shift. We also found that communication times varied substantially by provider, from a mean of 2 minutes per patient to greater than 12 minutes per patient.…”

Section: Discussionsupporting

confidence: 55%

“…Studies conducted at single institutions in the US [1][2][3] and elsewhere [4][5][6] have found that hospitalists generally spend little time communicating with their patients, and that there is often disagreement between doctors and both nurses and patients about the plan of care. 7,8 However, it is not known how much time physicians actually spend communicating with nurses and other physicians, and more importantly, whether more time spent communicating is associated with higher levels of agreement regarding the plan of care or greater patient satisfaction.…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Time Spent Communicating and Communication Outcomes on a Hospital Medicine Service

et al. 2011

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BACKGROUND: Quality care depends on effective communication between caregivers, but it is unknown whether time spent communicating is associated with communication outcomes. OBJECTIVE: To assess the association between time spent communicating, agreement on plan of care, and patient satisfaction. DESIGN: Time-motion study with cross-sectional survey. SETTING: Academic medical center. PARTICIPANTS: Physicians, patients, and nurses on a hospital medicine service. MEASUREMENTS: Hospitalists' forms of communication were timed with a stopwatch. Physician-nurse agreement on the plan of care and patient satisfaction with physician communication were assessed via survey. RESULTS: Eighteen hospitalists were observed caring for 379 patients. On average, physicians spent more time per patient on written than verbal communication (median: 9.2 min. vs. 6.3 min, p<0.001). Verbal communication was greatest with patients (mean time 5.3 min, range 0-37 min), then other physicians (1.4 min), families (1.1 min), nurses (1.1 min), and case managers (0.4 min). There was no verbal communication with nurses in 30% of cases. Nurses and physicians agreed most about planned procedures (87%), principal diagnosis (74%), tests ordered (73%), anticipated discharge date (69%) and least regarding medication changes (59%). There was no association between time spent communicating and agreement on plan of care. Among 123 patients who completed surveys (response rate 32%), time physicians spent talking to patients was not correlated with patients' satisfaction with physician communication (Pearson correlation coefficient = 0.09, p=0.30). CONCLUSIONS: Hospitalists vary in the amount of time they spend communicating, but we found no association between time spent and either patient satisfaction or nurse-physician agreement on plan of care.

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“…Of these, 142 papers were excluded based on the title and abstract, leaving 93 full-text papers to be screened for eligibility. Of these, 75 papers were excluded as they did not fit the inclusion criteria and two papers were unobtainable, even though interlibrary requests were submitted and the authors were contacted, leaving 16 papers [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] included in the review ( Table 9). …”

Section: Health Economic Study Methods and Resultsmentioning

confidence: 99%

Comparing the cost-effectiveness and clinical effectiveness of a new community in-reach rehabilitation service with the cost-effectiveness and clinical effectiveness of an established hospital-based rehabilitation service for older people: a pragmatic randomised controlled trial with microcost and qualitative analysis – the Community In-reach Rehabilitation And Care Transition (CIRACT) study

Sahota

Pulikottil-Jacob

Marshall

et al. 2016

Health Serv Deliv Res

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(2016) Comparing the cost-effectiveness and clinical effectiveness of a new community in-reach rehabilitation service with the cost-effectiveness and clinical effectiveness of an established hospital-based rehabilitation service for older people: a pragmatic randomised controlled trial with microcost and qualitative analysis -the Community In-reach Rehabilitation And Care Transition (CIRACT) study. Health Services and Delivery Research, 4 (7). ISSN 2050-4357 Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/33469/1/Sahota%20Health%20Serv%20Del%202016.pdf Copyright and reuse:The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the University of Nottingham End User licence and may be reused according to the conditions of the licence. For more details see: http://eprints.nottingham.ac.uk/end_user_agreement.pdf A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription.For more information, please contact eprints@nottingham.ac.uk This report should be referenced as follows: This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). HEALTH SERVICES AND DELIVERY RESEARCHEditorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the webs...

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Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians

Cited by 81 publications

References 41 publications

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

The Relationship Between Time Spent Communicating and Communication Outcomes on a Hospital Medicine Service

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