scholarly journals Nursing processes analysis in district hospital in Lithuania

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Vladickiene ◽  
A Stonkeviciute
Keyword(s):  
Internal Medicine ◽  
Patient Care ◽  
Nursing Staff ◽  
District Hospital ◽  
Medication Administration ◽  
Working Time ◽  
Human Potential ◽  
Direct Patient Care ◽  
Time And Motion ◽  
Nursing Processes

Abstract Background The aim of the study - to evaluate the time devoted to the activities of therapeutic profile nursing and wastes in the nursing processes. Methods Time-and-motion study was applied for investigation of clinical workflow in nursing at district hospital in neurology and internal medicine departments. A total of four nurses, two nurses from each department, were observed. Duration of observation was 2 940 minutes (49 hrs). Results Nurses devote most of their time to administering medicines. It has been noted that there are many additional, unnecessary actions in this process. Likewise nursing staff devotes a lot of time to documentation management work: refills the same dossier when the information is recorded in paper forms, and then transfer it to the computers. For communication with patients, nursing staff spend a very small part of their working time and it is due to insufficient staff and stress and fatigue of the nurses. It is observed that the nurses of neurology and internal medicine departments spent 50.3 percent of their working time for a direct patient care, 19.3 percent of time - for indirect patient care, 22.3 percent for personal time and 8.0 percent for unit-related functions. According to the Lean methodology waste of overproduction, waiting, defects, bureaucracy, transportation, motion and human potential were identified in these departments. Conclusions Nurses of neurology and internal medicine departments spend most of their time for direct patient care and the least of their time for unit-related duties. Seven out of eight types of waste prevails in therapeutic departments of the district hospital. Key messages Adaptation of the Lean methodology of ’Visual Management’ may aid for optimizing the process of medication administration and diminishing the paper work of nurses. The manifestation of the stress and fatigue of the nurses could be reduced if the workloads of nurses were adjusted and adequately distributed.

scholarly journals MANAGING HUMAN RESOURCES IN NURSING: THE RELATIONSHIP OF NURSES’ WORKING TIME AND PATIENTS’ INDEPENDENCE LEVEL

2019 ◽  
Vol 20 (1) ◽  
pp. 192-207
Author(s):  
Ramunė Čiarnienė ◽  
Roberta Suprikienė ◽  
Rūta Čiutienė ◽  
Asta Daunorienė ◽  
Olga Riklikienė
Keyword(s):  
Health Status ◽  
Human Resources ◽  
Patient Care ◽  
Quality Care ◽  
Relative Number ◽  
Working Time ◽  
Direct Patient Care ◽  
Nursing Time ◽  
Care Needs ◽  
Time And Motion

A skilled, competent, and motivated nursing workforce is crucial for a well-functioning health care system. Nurses’ professional activities done on a regular basis, their workload, and occupancy are related to the patient’s health status, dependence level and care needs. Therefore, managing human resources in nursing by effectively distributing nurses’ working time and monitoring their workload for safe and high quality care, managers should rely on the severity of patients’ health status and their independence level. In this article the results on how nurses’ working time depends on patients’ independence are provided. The research was carried out at a regional hospital, in departments of medical profile. The time-and-motion study was implemented with 72 observations made in total, which amounted to 777.2 hours of nursing time. A questionnaire was used to assess the level of patients’ independence by assessing the four activities of the patient’s daily living. The results revealed that the largest amount of nurses’ working time, i.e. almost half of a day’s shift, was spent on direct patient care by administrating medication use and performing various nursing procedures. Nurses would spend almost half of the time for direct patient care on completely dependent patients, while one third would be spent on dependent patients. The relative number of nurses’ contacts with a patient is directly proportional to patient’s level of independence; a strong or fairly strong linear relationship was established betweenn the level of patients’ independence and the relative amount of nurses’ working time.

scholarly journals Internal Medicine Residents' Time Study: Paperwork Versus Patient Care

2011 ◽  
Vol 3 (4) ◽  
pp. 550-553 ◽  
Author(s):  
Dalal Alromaihi ◽  
Amanda Godfrey ◽  
Tina Dimoski ◽  
Paul Gunnels ◽  
Eric Scher ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
General Practice ◽  
Patient Care ◽  
Health Care Workers ◽  
Direct Patient Care ◽  
Time Study ◽  
Structured Education ◽  
Internal Medicine Residents ◽  
Care Workers

Abstract Background Multiple factors affect residency education, including duty-hour restrictions and documentation requirements for regulatory compliance. We designed a work sampling study to determine the proportion of time residents spend in structured education, direct patient care, indirect patient care that must be completed by a physician, indirect patient care that may be delegated to other health care workers, and personal activities while on an inpatient general practice unit. Methods The 3-month study in 2009 involved 14 categorical internal medicine residents who volunteered to use personal digital assistants to self-report their location and primary tasks while on an inpatient general practice unit. Results Residents reported spending most of their time at workstations (43%) and less time in patient rooms (20%). By task, residents spent 39% of time on indirect patient care that must be completed by a physician, 31% on structured education, 17% on direct patient care, 9% on indirect patient care that may be delegated to other health care workers, and 4% on personal activities. From these data we estimated that residents spend 34 minutes per patient per day completing indirect patient care tasks compared with 15 minutes per patient per day in direct patient care. Conclusions This single-institution time study objectively quantified a current state of how and where internal medicine residents spend their time while on a general practice unit, showing that residents overall spend less time on direct patient care compared with other activities.

scholarly journals Inter-hospital comparison of working time allocation among internal medicine residents using time-motion observations: an innovative benchmarking tool

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033021
Author(s):  
Simon Martin Frey ◽  
Marie Méan ◽  
Antoine Garnier ◽  
Julien Castioni ◽  
Nathalie Wenger ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Time Allocation ◽  
Postgraduate Training ◽  
Working Time ◽  
University Hospital ◽  
Direct Patient Care ◽  
Time Motion ◽  
Internal Medicine Residents ◽  
Working Day ◽  
Hospital Comparison

ObjectivesThe vast majority of residents’ working time is spent away from patients. In hospital practice, many factors may influence the resident’s working day structure.Using an innovative method, we aimed to compare working time allocation among internal medicine residents using time-motion observations. The first study goal was to describe how the method could be used for inter-hospital comparison. The secondary goal was to learn about specific differences in the resident’s working day structure in university and non-university hospital settings.DesignTwo separate time-motion studies. Trained peer-observers followed the residents during weekday day shifts with a tablet, able to record 22 different activities and corresponding context (with patient, phone, colleague or computer).SettingInternal medicine residencies at a university (May–July 2015) and a non-university (September–October 2016) community hospital.Participants28 residents (mean age: 29 years, average postgraduate training: 30 months) at university hospital, 21 residents (mean age: 30 years, average postgraduate training: 17 months) at non-university hospital.OutcomesTime spent with patients and time dedicated to activities directly related to patients; description of main differences of time allocation between hospitals.ResultsCumulatively 1051 hours of observation (566 (university hospital)+486 (non-university hospital)) and 92 day shifts (49+43) were evaluated. Daily working time was 11.5 versus 11.3 hours. A median daily period of 195 min (IQR 179–211, 27.9%) and 116 min (IQR 98–134, 17.2%) (p<0.001) was dedicated to direct patient care, respectively.ConclusionsWe successfully identified differences potentially related to each hospital structure and organisation. Inter-hospital comparisons could help set up interventions aiming to improve workday structure and experience of residents.

Introduction of computerized provider order entry (CPOE) and time impact in an inpatient hematology/oncology service: Serial time and motion studies

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17507-e17507
Author(s):  
D. A. Hanauer ◽  
R. W. Beasley ◽  
J. Schumacher ◽  
M. G. Duck ◽  
D. W. Blayney
Keyword(s):  
Patient Care ◽  
Physician Assistants ◽  
House Staff ◽  
Direct Patient Care ◽  
Care Providers ◽  
Order Entry ◽  
Time And Motion ◽  
Oncology Service ◽  
The Impact ◽  
Productive Time

e17507 Background: The impact of CPOE on inpatient hematology/oncology care is not well studied. CPOE has many benefits, but concerns exist about increased time required to enter electronic orders compared to handwritten orders. We hypothesized that CPOE would require more order-related time from caregivers, and reduce the amount of time for direct patient care. Methods: Physician assistants (PAs) enter all patient orders (except those for chemotherapy) and are the dedicated and exclusive care providers on this non-house staff service at the main Hospital of the University of Michigan Health System. We chose the PA service for observation as we could eliminate potential biases introduced by rotating house staff we observed in earlier studies. PAs were directly observed at -1, +3 and +8 months post implementation of a CPOE system (Sunrise Clinical Manager, Eclypsis, Atlanta GA). Dedicated observers used a data entry tool with a modified database (available on the Health IT Tools section at healthit.ahrq.gov) on a tablet computer. For analysis, the 60 individual activities were grouped into 6 major categories, as well as an ordering category. We observed the same three PAs for 82.5 hours pre-CPOE, for 75.0 hours at 3 months post and for 70.5 hours 8 months post. Productive time was all non-personal and non-administrative time. The faculty entered chemotherapy orders and supervised the PAs, but were not studied. Results: Overall time for order-related activities was unchanged during the three observation periods, requiring 10.3, 10.6 and 11.4% of productive time, respectively. Time spent on direct patient care (as a percentage of productive time) was also unchanged once CPOE was implemented (50.7% pre vs. 49.8% and 47.8% post). Conclusions: We could not detect differences in order-entry time by well-trained PAs using standardized order sets before and after CPOE implementation on an inpatient hematology/oncology service. The decision to adopt CPOE should not be based on the hypothesis that there will be less (or more) time spent on order entry tasks. No significant financial relationships to disclose.

scholarly journals Understanding Nursing Workflow for Inpatient Education Delivery: Time and Motion Study

JMIR Nursing ◽  
10.2196/15658 ◽  
2019 ◽  
Vol 2 (1) ◽  
pp. e15658
Author(s):  
Kelley M Baker ◽  
Michelle F Magee ◽  
Kelly M Smith
Keyword(s):  
Patient Care ◽  
Diabetes Education ◽  
Direct Patient Care ◽  
Patient Room ◽  
Time And Motion Study ◽  
Time And Motion ◽  
Motion Study ◽  
The Mean ◽  
Education Delivery ◽  
Mean Time

Background Diabetes self-management education and support improves diabetes-related outcomes, but many persons living with diabetes do not receive this. Adults with diabetes have high hospitalization rates, so hospital stays may present an opportunity for diabetes education. Nurses, supported by patient care technicians, are typically responsible for delivering patient education but often do not have time. Using technology to support education delivery in the hospital is one potentially important solution. Objective The aim of this study was to evaluate nurse and patient care technician workflow to identify opportunities for providing education. The results informed implementation of a diabetes education program on a tablet computer in the hospital setting within existing nursing workflow with existing staff. Methods We conducted a time and motion study of nurses and patient care technicians on three medical-surgical units of a large urban tertiary care hospital. Five trained observers conducted observations in 2-hour blocks. During each observation, a single observer observed a single nurse or patient care technician and recorded the tasks, locations, and their durations using a Web-based time and motion data collection tool. Percentage of time spent on a task and in a location and mean duration of task and location sessions were calculated. In addition, the number of tasks and locations per hour, number of patient rooms visited per hour, and mean time between visits to a given patient room were determined. Results Nurses spent approximately one-third of their time in direct patient care and much of their time (60%) on the unit but not in a patient room. Compared with nurses, patient care technicians spent a significantly greater percentage of time in direct patient care (42%; P=.001). Nurses averaged 16.2 tasks per hour, while patient care technicians averaged 18.2. The mean length of a direct patient care session was 3:42 minutes for nurses and 3:02 minutes for patient care technicians. For nurses, 56% of task durations were 2 minutes or less, and 38% were one minute or less. For patient care technicians, 62% were 2 minutes or less, and 44% were 1 minute or less. Nurses visited 5.3 and patient care technicians 9.4 patient rooms per hour. The mean time between visits to a given room was 37:15 minutes for nurses and 33:28 minutes for patient care technicians. Conclusions The workflow of nurses and patient care technicians, constantly in and out of patient rooms, suggests an opportunity for delivering a tablet to the patient bedside. The average time between visits to a given room is consistent with bringing the tablet to a patient in one visit and retrieving it at the next. However, the relatively short duration of direct patient care sessions could potentially limit the ability of nurses and patient care technicians to spend much time with each patient on instruction in the technology platform or the content.

Implementation of Computerized Provider Order Entry (CPOE) Does Not Impact Provider Work Time in An Inpatient Malignant Hematology Service

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4704-4704
Author(s):  
David A Hanauer ◽  
Sung W Choi ◽  
Robert W Beasley ◽  
Ronald B Hirschl ◽  
Douglas W Blayney
Keyword(s):  
Patient Care ◽  
Training Session ◽  
Direct Patient Care ◽  
Order Entry ◽  
Time And Motion Study ◽  
Time And Motion ◽  
Motion Study ◽  
Order Sets ◽  
Before And After ◽  
The Impact

Abstract No data are available concerning the impact of CPOE on inpatient leukemia and lymphoma care. CPOE may improve patient safety, reduce time between order entry and medication administration, and reduce medication and transcription errors. However, concerns have arisen about potential increased time required to enter electronic orders compared to handwritten orders. Our hypothesis was that CPOE would require more order-related time from caregivers, and reduce the amount of time for direct patient care. We studied the work patterns of three Physician Assistants (PAs) who worked under the supervision of faculty physicians, and were the exclusive inpatient care providers. The PA-staffed hematology service was chosen to minimize the impact of rotating house staff on our results. Faculty, who were not studied, entered the few chemotherapy orders necessary, while PAs entered orders for hydration, antibiotics, supportive care and other medications, and for consultations and diagnostic tests. The UMHS Institutional Review Board reviewed the study protocol and waived the requirement for patient informed consent. We performed a direct observation time and motion study pre- and post-implementation of a commercial CPOE system (Sunrise Clinical Manager™ 4.5, Eclipsys, Boca Raton, Florida) on one inpatient hematology service at the UMHS University Hospital. The same three PAs were shadowed pre- and post-implementation. We also closely matched morning and afternoon observation times in order to reduce variability in activities taking place at different times of the day. Prior to CPOE implementation the PAs had a 4 hour general training session and a 1 hour chemotherapy training session. Pre-built order sets were routinely used by the PAs. A portable tablet computer was used by an independent observer to record data, using a data entry interface containing 63 individual activity categories modified from the Time and Motion database under “IT Tools” at http://www.ahrq.gov. Data were grouped into subcategories for analysis. We grouped 12 activities as ordering-related (e.g. writing orders, writing forms, clarifying orders, etc.) We observed the same three PAs for 85.4 hours (over 2 weeks) pre, and for 75.8 hours (over 4 weeks) starting 3 months post-CPOE. Mean patient census was 11.3 per day pre- and 9.2 per day post implementation observation periods. Overall time for order-related activities was unchanged, requiring 7.7% of total time pre- and 8.1% of total time post-CPOE even though actual order writing took longer with CPOE compared to written (4.9% pre vs. 7.0% post). CPOE had almost no impact on direct patient care time (Figure), with PAs spending 38.2% total time on direct patient care pre-CPOE compared to 38.4% post. A minimal difference was also found with the overall total for indirect patient care activities (37.1% pre vs. 38.7% post). Our results suggest that using CPOE on a busy hematology inpatient service has minimal impact on time spent by trained PAs using standard order sets 3 months after implementation. The decision to adopt CPOE for a busy hematology service should not be based on the hypothesis that there will be a change in workflow or task organization. More study is needed to determine if CPOE for hematology patients results in a change in the quality of patient care or safety. Figure. Percentage of total time spent in 6 analysis categories both before and after implementation of a commercial CPOE system for an inpatient hematology service. These 6 categories represent 63 individual activities categories that were recorded in the time and motion study. Error bars represent 95% confidence intervals. Figure. Percentage of total time spent in 6 analysis categories both before and after implementation of a commercial CPOE system for an inpatient hematology service. These 6 categories represent 63 individual activities categories that were recorded in the time and motion study. Error bars represent 95% confidence intervals.

scholarly journals Understanding Nursing Workflow for Inpatient Education Delivery: Time and Motion Study (Preprint)

2019 ◽  
Author(s):  
Kelley M Baker ◽  
Michelle F Magee ◽  
Kelly M Smith
Keyword(s):  
Patient Care ◽  
Diabetes Education ◽  
Direct Patient Care ◽  
Patient Room ◽  
Time And Motion Study ◽  
Time And Motion ◽  
Motion Study ◽  
The Mean ◽  
Education Delivery ◽  
Mean Time

BACKGROUND Diabetes self-management education and support improves diabetes-related outcomes, but many persons living with diabetes do not receive this. Adults with diabetes have high hospitalization rates, so hospital stays may present an opportunity for diabetes education. Nurses, supported by patient care technicians, are typically responsible for delivering patient education but often do not have time. Using technology to support education delivery in the hospital is one potentially important solution. OBJECTIVE The aim of this study was to evaluate nurse and patient care technician workflow to identify opportunities for providing education. The results informed implementation of a diabetes education program on a tablet computer in the hospital setting within existing nursing workflow with existing staff. METHODS We conducted a time and motion study of nurses and patient care technicians on three medical-surgical units of a large urban tertiary care hospital. Five trained observers conducted observations in 2-hour blocks. During each observation, a single observer observed a single nurse or patient care technician and recorded the tasks, locations, and their durations using a Web-based time and motion data collection tool. Percentage of time spent on a task and in a location and mean duration of task and location sessions were calculated. In addition, the number of tasks and locations per hour, number of patient rooms visited per hour, and mean time between visits to a given patient room were determined. RESULTS Nurses spent approximately one-third of their time in direct patient care and much of their time (60%) on the unit but not in a patient room. Compared with nurses, patient care technicians spent a significantly greater percentage of time in direct patient care (42%; <italic>P</italic>=.001). Nurses averaged 16.2 tasks per hour, while patient care technicians averaged 18.2. The mean length of a direct patient care session was 3:42 minutes for nurses and 3:02 minutes for patient care technicians. For nurses, 56% of task durations were 2 minutes or less, and 38% were one minute or less. For patient care technicians, 62% were 2 minutes or less, and 44% were 1 minute or less. Nurses visited 5.3 and patient care technicians 9.4 patient rooms per hour. The mean time between visits to a given room was 37:15 minutes for nurses and 33:28 minutes for patient care technicians. CONCLUSIONS The workflow of nurses and patient care technicians, constantly in and out of patient rooms, suggests an opportunity for delivering a tablet to the patient bedside. The average time between visits to a given room is consistent with bringing the tablet to a patient in one visit and retrieving it at the next. However, the relatively short duration of direct patient care sessions could potentially limit the ability of nurses and patient care technicians to spend much time with each patient on instruction in the technology platform or the content.

scholarly journals Less is more: a rationalization of daily labwork

2018 ◽  
Vol 9 (4) ◽  
pp. e135-137
Author(s):  
Barry Chan ◽  
Alasdair Nazerali-Maitland ◽  
Wilma Hopman ◽  
David Zelt ◽  
Ross Morton
Keyword(s):  
Internal Medicine ◽  
Patient Care ◽  
Treatment Response ◽  
Financial Impact ◽  
Direct Patient Care ◽  
Less Is More ◽  
Processing Times ◽  
Summative Feedback

Routine daily phlebotomy can often act as a replacement for direct patient care.  Some tests are necessary to gauge treatment response, however many are unnecessary and increase a patient’s risk of complications and can impede laboratory processing times. This study addresses the effects of providing resident trainees, who often lack an understanding of the financial impact of the tests they order, with summative feedback. This encouraged them to be resource-conscious. Internal Medicine teams were provided with weekly laboratory spending reports and this resulted in a 33% reduction in Per Person Per Day spending. No changes in mortality were noted.

scholarly journals Internal Medicine Residents' Computer Use in the Inpatient Setting

2012 ◽  
Vol 4 (4) ◽  
pp. 529-532 ◽  
Author(s):  
Amy S. Oxentenko ◽  
Chinmay U. Manohar ◽  
Christopher P. McCoy ◽  
William K. Bighorse ◽  
Furman S. McDonald ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Care ◽  
Computer Use ◽  
Hospital Setting ◽  
Direct Patient Care ◽  
Inpatient Setting ◽  
Work Redesign ◽  
General Internal ◽  
Internal Medicine Residents ◽  
Computer Based

Abstract Background Studies have suggested that patient contact time for internal medicine residents is decreasing and being replaced with computer-related activities, yet objective data regarding computer use by residents are lacking. Objective The aim of this study was to objectively measure time use by internal medicine residents while on duty in the hospital setting using real-time, voice-capture technology. Methods First- and third-year categoric internal medicine residents participated (n  =  25) during a 3-month period in 2010 while rotating on general internal medicine rotations. Portable speech-recognition technology was used to record residents' activities. The residents were prompted every 15 minutes from an earpiece and asked to categorize the activity they had been doing since the last prompt, choosing from a predetermined list of 15 activities. Results Of the 1008 duty-time responses, 493 (49%) were classified as computer-related activities, whereas 341 (34%) were classified as direct patient care, 110 (11%) were classified as noncomputer-related education, and 64 (6%) were classified as other activities. Of resident reported computer-use time, 70% was spent on patient notes and order entry. Conclusions The results of our study suggest that computer use is the predominant activity for internal medicine residents while in the inpatient setting. Work redesign because of duty hour regulations should consider how to free up residents' time from computer-based activities to allow residents to engage in more direct patient care and noncomputer-based learning.

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