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.

scholarly journals Time is of the essence: an observational time-motion study of internal medicine residents while they are on duty

2017 ◽  
Vol 8 (3) ◽  
pp. e49-70
Author(s):  
Cameron Leafloor ◽  
Erin (Yiran) Liu ◽  
Cathy Code ◽  
Heather Lochnan ◽  
Erin Keely ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Information Transfer ◽  
Observation Time ◽  
Direct Patient Care ◽  
Self Directed Learning ◽  
Time Motion ◽  
Motion Study ◽  
Internal Medicine Residents ◽  
Communication Time ◽  
Duty Time

Background: The effects of changes to resident physician duty hours need to be measureable. This time-motion study was done to record internal medicine residents’ workflow while on duty and to determine the feasibility of capturing detailed data using a mobile electronic tool.Methods: Junior and senior residents were shadowed by a single observer during six-hour blocks of time, covering all seven days. Activities were recorded in real-time. Eighty-nine activities grouped into nine categories were determined a priori.Results: A total of 17,714 events were recorded, encompassing 516 hours of observation. Time was apportioned in the following categories: Direct Patient Care (22%), Communication (19%), Personal tasks (15%), Documentation (14%), Education (13%), Indirect care (11%), Transit (6%), Administration (0.6%), and Non-physician tasks (0.4%). Nineteen percent of the education time was spent in self-directed learning activities. Only 9% of the total on duty time was spent in the presence of patients. Sixty-five percent of communication time was devoted to information transfer. A total of 968 interruptions were recorded which took on average 93.5 seconds each to service.Conclusion: Detailed recording of residents’ workflow is feasible and can now lead to the measurement of the effects of future changes to residency training. Education activities accounted for 13% of on-duty time. 

scholarly journals Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations

2019 ◽  
Vol 179 (6) ◽  
pp. 760 ◽  
Author(s):  
Krisda H. Chaiyachati ◽  
Judy A. Shea ◽  
David A. Asch ◽  
Manqing Liu ◽  
Lisa M. Bellini ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Time Allocation ◽  
First Year ◽  
Time Motion ◽  
Internal Medicine Residents

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.

Burnout syndrome during residency in internal medicine and pediatrics in a country without working time directive

2014 ◽  
Vol 27 (3) ◽  
pp. 223-230 ◽  
Author(s):  
Duygu Yazgan Aksoy ◽  
Mine Durusu Tanriover ◽  
Sule Unal ◽  
Omer Dizdar ◽  
Umut Kalyoncu ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Design Methodology ◽  
Working Time ◽  
Personal Accomplishment ◽  
Burnout Syndrome ◽  
Content Type ◽  
Item Questionnaire ◽  
Internal Medicine Residents ◽  
Clinically Significant ◽  
Working Time Directive

Purpose – The purpose of this paper is to demonstrate burnout syndrome among internal medicine and pediatrics residents in a country that does not have the working time directive (WTD) and also to determine the risk factors and consequent impact on efficient functioning in clinical areas. Design/methodology/approach – A 57-item questionnaire was given to internal medicine and pediatrics residents. Responses from 22 pediatrics and 33 internal medicine residents were evaluated. Findings – Demographic findings, burnout scores, having hobbies, social activities and reading books unrelated to medicine were similar between the two groups. Six pediatrics residents (27.3 per cent) and 11 (33.3 per cent) internal medicine residents met the criteria for clinically significant burnout. Personal accomplishment scores and reading books unrelated to medicine were found to be related to burnout. Originality/value – Burnout is a syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal accomplishment. It is important to document burnout in countries where WTDs are not implemented. Further studies might demonstrate burnout's effect on patient safety, service quality and physician's performance.

scholarly journals Time-motion studies of internal medicine residents' duty hours: a systematic review and meta-analysis

2015 ◽  
pp. 621
Author(s):  
Allen Huang ◽  
Cameron Leafloor ◽  
Heather Lochnan ◽  
Catherine Code ◽  
Erin Keely ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Systematic Review ◽  
Meta Analysis ◽  
Duty Hours ◽  
Time Motion ◽  
Internal Medicine Residents ◽  
Motion Studies

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.

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.

Time Allocation and Well-Being in Internal Medicine Residents: A Multi-Institutional Cross-Sectional Survey

2020 ◽  
Vol 133 (4) ◽  
pp. 515-519
Author(s):  
Rebecca E. Miller ◽  
Matthew Kelleher ◽  
Ashley Duckett ◽  
Paul O'Rourke ◽  
Miao-Shan Yen ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Time Allocation ◽  
Well Being ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents
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