Abstract
BackgroundRecent implementation of electronic health records (EHR) has dramatically changed medical ward organization. While residents in general internal medicine use EHR systems half of their working time, whether computer usage impacts residents’ workflow remains uncertain. We aimed to observe the frequency of task-switches occurring during resident’s work and to assess whether computer usage was associated with task-switching.MethodsIn a large Swiss academic university hospital, we conducted, between May 26 and July 24, 2015 a time-motion study to assess how residents in general internal medicine organize their working day.ResultsWe observed 49 day and 17 evening shifts of 36 residents, amounting to 697 working hours. During day shifts, residents spent 5.4 hours using a computer (mean total working time: 11.6 hours per day). On average, residents switched 15 times per hour from a task to another. Task-switching peaked between 8:00–9:00 and 16:00–17:00. Task-switching was not associated with resident’s characteristics and no association was found between task-switching and extra hours (Spearman r = 0.220, p = 0.137 for day and r = 0.483, p = 0.058 for evening shifts). Computer usage occurred more frequently at the beginning or ends of day shifts and was associated with decreased overall task-switching.ConclusionTask-switching occurs very frequently during resident’s working day. Despite the fact that residents used a computer half of their working time, computer usage was associated with decreased task-switching. Whether frequent task-switches and computer usage impact the quality of patient care and resident’s work must be evaluated in further studies.
Highlights
Frequent switches in resident’s ongoing tasks might have negative effects on patient safety because of the physical and cognitive workload and discontinuity in medical attention but might impact resident’s capacity to organize a workday [1, 2].Few quantitative studies focusing on frequency of task-switches occurring during resident’s work in general internal medicine have been published and comparisons are limited by different health systems and medical education programmes [1, 3].Recent implementation of electronic health records (EHR) has dramatically changed medical ward organization [4]
A recent time motion study conducted in an ambulatory setting showed that physicians interacted with EHR during one third of the time they spent with patients [8], which differs from our hospital setting where residents in internal medicine seldom do so [9]
We considered five tasks as medically important: 1) daily rounds of patients in charge; 2) giving or receiving handoff with the goal to transfer patient responsibility; 3) writing in EHR; 4) meetings families; 5) receiving or providing academic teaching
Summary
Frequent switches in resident’s ongoing tasks might have negative effects on patient safety because of the physical and cognitive workload and discontinuity in medical attention but might impact resident’s capacity to organize a workday [1, 2].Few quantitative studies focusing on frequency of task-switches occurring during resident’s work in general internal medicine have been published and comparisons are limited by different health systems and medical education programmes [1, 3].Recent implementation of electronic health records (EHR) has dramatically changed medical ward organization [4]. Frequent switches in resident’s ongoing tasks might have negative effects on patient safety because of the physical and cognitive workload and discontinuity in medical attention but might impact resident’s capacity to organize a workday [1, 2]. Few quantitative studies focusing on frequency of task-switches occurring during resident’s work in general internal medicine have been published and comparisons are limited by different health systems and medical education programmes [1, 3]. While residents in internal medicine use EHR systems half of their working time [4], whether computer usage impacts residents’ workflow remains uncertain. While residents in general internal medicine use EHR systems half of their working time, whether computer usage impacts residents’ workflow remains uncertain. We aimed to observe the frequency of task-switches occurring during resident’s work and to assess whether computer usage was associated with task-switching
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