Background:
Work‐hour restrictions are intended to improve resident education and patient care. This study quantifies the time interns and residents spend on direct patient care, indirect patient care, computer tasks, and education.
Methods:
This is a prospective time–motion study at an academic medical center. The team consists of 2 interns, 1 resident, every fourth night call, and daily “dripped” admissions. A researcher shadowed house staff on noncall weekdays. Time spent on direct and indirect patient care, computer entry, nurse contact, and educational and other activities was measured. Two surveys were given to the participants the day after their observation. The first asked their perception of time allotted to each of the monitored activities and the second inquired into their off–work hour activities.
Results:
Eight interns and 6 residents were followed, totaling 10,130 minutes (168.8 hours) of observation time. Because of mandatory days off and clinics, only 2 of the 14 noncall days (14%) had a fully staffed team. On average, interns saw 6 patients, 1 admission, and 1.6 discharges daily. Residents worked 1.4 hours less per day than interns. The average intern workday was 12.7 hours. On direct contact patient care, residents spent 1.9 hrs (16.7%) and interns 2.3 hrs (18%) per day. In noncontact patient‐care discussions, residents spent 2.1 hrs (18.9%), interns 1.7 hrs (13.6%) per day. Residents spent 3.8 hours (33.6%) and interns 4.9 hours (38.8%) on the computer. Residents and interns spent 21 minutes (3%) and 18 minutes (2.4%), respectively, on direct nursing communication. Educational activities were 41 minutes (6%) for residents and 23 minutes (3%) for interns. Nonwork activities were 1.7 hours (15.5%) for residents and 2.4 hours (18.8%) for interns. The first survey revealed that house staff's perception of tasks was within 19% of the actual time. The second survey revealed that house staff averaged 6.6 hours of sleep and did little else other than eat and travel, spending on average 8.6 minutes on educational reading at home.
Conclusions:
Eighty‐six percent of noncall days are managed with less than 3 house staff members per team. Interns and residents spend nearly equivalent hours (2 hours) performing direct patient care. Residents' total patient care (4.0 hours) was equivalent to their time spent on the computer (3.8 hours). Interns spent more time on the computer (4.9 hours). Personal nurse interaction, mostly during team rounds, was 20 minutes per day. Our findings raise concern that the current team structure, work‐hour restrictions, and computer entry have undesirable consequences on resident development and patient care. There is little discrimination between the distribution of daily tasks between interns and residents. Residents are losing their supervisory, educational role to that of completing interns' work. Completing tasks within a “work shift” with less than a full team limits educational time. Five hours in a computer room limits personal interactions with patients and nurses.