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

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.

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

BMJ Open ◽

10.1136/bmjopen-2019-033021 ◽

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.

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Internal Medicine Residents' Time Study: Paperwork Versus Patient Care

Journal of Graduate Medical Education ◽

10.4300/jgme-d-11-00057.1 ◽

2011 ◽

Vol 3 (4) ◽

pp. 550-553 ◽

Cited By ~ 9

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.

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Internal Medicine Residents' Acceptance of Self-Directed Learning Plans at the Point of Care

Journal of Graduate Medical Education ◽

10.4300/jgme-03-03-30 ◽

2011 ◽

Vol 3 (3) ◽

pp. 425-428 ◽

Cited By ~ 8

Author(s):

Susan J Smith ◽

Radhika R Kakarala ◽

Siva K Talluri ◽

Parul Sud ◽

J Parboosingh

Keyword(s):

Internal Medicine ◽

Point Of Care ◽

First Year ◽

Knowledge Gaps ◽

Self Directed Learning ◽

Perceptions And Attitudes ◽

Internal Medicine Residents ◽

Directed Learning ◽

Clinical Questions ◽

Learning Plans

Abstract Objectives We implemented a curriculum using self-directed learning plans (SDLPs) based on clinical questions arising from the residents' practice, and we report on perceptions and attitudes from residents in internal medicine regarding the use of SDLPs conceived at point of care. Methods Internal medicine residents at a single community hospital in the Midwest were surveyed in 2006 regarding SDLPs. We report their perceived effectiveness in identifying knowledge gaps, the processes used to fill those gaps, and the resident outcomes using descriptive statistics. Results A total of 26 out of 37 residents (70%) responded. Most (24 of 26; 92%) perceived SDLPs helped them to identify and fill knowledge gaps and that their skills in framing questions (23 of 26; 88%), identifying resources (21 of 26; 81%), and critically appraising the evidence (20 of 26; 77%) improved through regular use. They also felt these plans led to a meaningful change in their practice or provided further direction for learning (17 of 26; 65%). Most (21 of 26; 81%) reported their intent to include point-of-care learning in their continuing education after residency. We found no significant differences in the responses of first-year compared with second- or third-year residents. Conclusions Questions arising during patient care are strong motivators for physician self-directed learning. The residents' responses indicated that they accepted the SDLPs and intend to use them in practice. Embedding the discussion of the SDLPs in preclinic conferences has ensured sustainability during the past 5 years and has enabled us to demonstrate teaching of practice-based learning and improvement.

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Medication reconciliation in hospital patients over the age of 65: How long does it take and how much does it cost? A time-motion study in an internal medicine ward

European Journal of Internal Medicine ◽

10.1016/j.ejim.2019.12.003 ◽

2020 ◽

Vol 73 ◽

pp. 100-102

Author(s):

L. Alix ◽

E. Bajeux ◽

J. Hubert ◽

B. Cador ◽

J.M. Josselin ◽

...

Keyword(s):

Internal Medicine ◽

Medication Reconciliation ◽

Internal Medicine Ward ◽

Time Motion ◽

Motion Study ◽

Hospital Patients

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Emergency department physicians’ distribution of time in the fast paced-workflow-a novel time-motion study of drug-related activities

International Journal of Clinical Pharmacy ◽

10.1007/s11096-021-01364-6 ◽

2021 ◽

Author(s):

Lisbeth D. Nymoen ◽

Therese Tran ◽

Scott R. Walter ◽

Elin C. Lehnbom ◽

Ingrid K. Tunestveit ◽

...

Keyword(s):

Emergency Department ◽

Observation Time ◽

Transitions Of Care ◽

Healthcare Personnel ◽

Bootstrap Analysis ◽

Time Motion ◽

Motion Study ◽

Efficient Information ◽

Observation Method ◽

A Minor

AbstractBackground In the emergency department physicians are forced to distribute their time to ensure that all admitted patients receive appropriate emergency care. Previous studies have raised concerns about medication discrepancies in patient’s drug lists at admission to the emergency department. Thus, it is important to study how emergency department physicians distribute their time, to highlight where workflow redesign can be needed.Aim to quantify how emergency department physicians distribute their time between various task categories, with particular focus on drug-related tasks.Method Direct observation, time-motion study of emergency department physicians at Diakonhjemmet Hospital, Oslo, Norway. Physicians’ activities were categorized in discrete categories and data were collected with the validated method of Work Observation Method By Activity Timing between October 2018 to January 2019. Bootstrap analysis determined 95% confidence intervals for proportions and interruption rates.Results During the observation time of 91.4 h, 31 emergency department physicians were observed. In total, physicians spent majority of their time gathering information (36.5%), communicating (26.3%), and documenting (24.2%). Further, physicians spent 17.8% (95% CI 16.8%, 19.3%) of their time on drug-related tasks. On average, physicians spent 7.8 min (95% CI 7.2, 8.6) per hour to obtain and document patients’ drug lists.Conclusion Emergency department physicians are required to conduct numerous essential tasks and distributes a minor proportion of their time on drug-related tasks. More efficient information flow regarding drugs should be facilitated at transitions of care. The presence of healthcare personnel dedicated to obtaining drug lists in the emergency department should be considered.

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

JAMA Internal Medicine ◽

10.1001/jamainternmed.2019.0095 ◽

2019 ◽

Vol 179 (6) ◽

pp. 760 ◽

Cited By ~ 19

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

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MP02: The impact of adoption of an electronic health record on emergency physician work: a time motion study

CJEM ◽

10.1017/cem.2020.150 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S42-S43

Author(s):

S. Calder-Sprackman ◽

G. Clapham ◽

T. Kandiah ◽

J. Choo-Foo ◽

S. Aggarwal ◽

...

Keyword(s):

Electronic Health Record ◽

Patient Care ◽

Emergency Physician ◽

Chart Review ◽

Direct Patient Care ◽

Health Record ◽

Physical Movement ◽

Time Motion ◽

Motion Study ◽

The Impact

Introduction: Adoption of a new Electronic Health Record (EHR) can introduce radical changes in task allocation, work processes, and efficiency for providers. In June 2019, The Ottawa Hospital transitioned from a primarily paper based EHR to a comprehensive EHR (Epic) using a “big bang” approach. The objective of this study was to assess the impact of the transition to Epic on Emergency Physician (EP) work activities in a tertiary care academic Emergency Department (ED). Methods: We conducted a time motion study of EPs on shift in low acuity areas of our ED (CTAS 3-5). Fifteen EPs representing a spectrum of pre-Epic baseline workflow efficiencies were directly observed in real-time during two 4-hour sessions prior to EHR implementation (May 2019) and again in go live (August 2019). Trained observers performed continuous observation and measured times for the following EP tasks: chart review, direct patient care, documentation, physical movement, communication, teaching, handover, and other (including breaks). We compared time spent on tasks pre Epic and during go live and report mean times for the EP tasks per patient and per shift using two tailed t-test for comparison. Results: All physicians had a 17% decrease in patients seen after Epic implementation (2.72/hr vs 2.24/hr, p < 0.01). EPs spent the same amount of time per patient on direct patient care and chart review (direct patient care: 9min06sec/pt pre vs 8min56sec/pt go live, p = 0.77; chart review: 2min47sec/pt pre vs 2min50sec/pt go live, p = 0.88), however, documentation time increased (5min28sec/pt pre vs 7min12sec/pt go live, p < 0.01). Time spent on shift teaching learners increased but did not reach statistical significance (31min26sec/shift pre vs 36min21sec/shift go live, p = 0.39), and time spent on non-patient-specific activities – physical movement, handover, team communication, and other – did not change (50min49sec/shift pre vs 50min53sec/shift go live, p = 0.99). Conclusion: Implementation of Epic did not affect EP time with individual patients - there was no change in direct patient care or chart review. Documentation time increased and EP efficiency (patients seen per hr on shift) decreased after go live. Patient volumes cannot be adjusted in the ED therefore anticipating the EHR impact on EP workflow is critical for successful implementation. EDs may consider up staffing 20% during go live. Findings from this study can inform how to best support EDs nationally through transition to EHR.

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