Since our program conducted a time study to see how hospitalists spend their time 4 years ago, we have significantly increased our daytime coverage as well as our average daily census (more than doubled). To evaluate these changes, we conducted a more robust follow‐up study aiming to validate our original findings and to assess how the amount of time hospitalists spend in clinical activities might change as workload increases.
Trained observers shadowed each of 24 hospitalists for 2 full‐day shifts using Workstudy+® software installed on a handheld device, the Palm TX. The software allowed observers to record the frequency and duration of activities performed by hospitalists. Daily census volumes were also collected. Of the 48 days of observation, 22 were considered high volume (≥14 patients), whereas 26 were considered low volume (<14 patients). For the categories of direct and indirect patient care, we used t tests to compare the time spent per patient on high‐ and low‐volume days, indirect patient care activities included communication, electronic medical record (EMR) usage, other indirect patient care, travel, and waiting. The effect of admission and discharge volume was also analyzed using a t test (high‐volume admitting day ≥ 2 admissions, high‐volume discharge day ≥ 3 discharges).
Despite increasing the daytime coverage from 5 to 9 hospitalists on duty at a time and increasing the average census from 9.4 ± 4.0 to 13.2 ± 2.0 patients over the last 4 years, the distribution of time among the major activities was consistent with the original study. The distribution of time spent across activities changed as the hospitalists' workload changed. Hospitalists spent the same amount of time per patient in direct patient care on high‐volume days compared with on low‐volume days, (9.3 ± 2.8 vs. 8.6 ± 3.0 minutes, P = 0.40). The length of the workday was also comparable (high 627.5 ± 55.4 vs. low 613.1 ± 48.1 minutes, P = 0.35). However, hospitalists spent less time on indirect patient care activities on high‐volume days compared with that on low‐volume days (32.8 ± 5.1 vs. 39.6 ± 6.2 minutes per patient, P = 0.0001). This difference was mainly a result of a reduction in communication and EMR usage (2.4 ± 0.9 and 3.2 ± 1.1 fewer minutes, respectively). High‐volume admission and discharge days did not significantly differ from low‐volume days (P> 0.4 for all activities).
Time sampling of work activities appears to be equally as efficacious as comprehensive monitoring for a hospitalist time‐work flow study. During periods of higher workload, hospitalists spent less overall time per patient in indirect patient care, specifically in activities related to communication and EMR usage, but time spent on direct patient care was preserved. The implications of these differences are unclear.
D. Magill, none; K. Englert, none; D. Malkenson, none; M. Tipping, none; V. Forth, none; M. Williams, Society of Hospital Medicine, Editor.