Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians

Matthias Weigl,Peter Angerer,Andreas Müller,Andrea Zupanc

doi:10.1186/1472-6963-9-110

Matthias Weigl, Peter Angerer + Show 2 more

Open Access

https://doi.org/10.1186/1472-6963-9-110

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Abstract

BackgroundHospital physicians' time is a critical resource in medical care. Two aspects are of interest. First, the time spent in direct patient contact – a key principle of effective medical care. Second, simultaneous task performance ('multitasking') which may contribute to medical error, impaired safety behaviour, and stress. There is a call for instruments to assess these aspects. A preliminary study to gain insight into activity patterns, time allocation and simultaneous activities of hospital physicians was carried out. Therefore an observation instrument for time-motion-studies in hospital settings was developed and tested.Methods35 participant observations of internists and surgeons of a German municipal 300-bed hospital were conducted. Complete day shifts of hospital physicians on wards, emergency ward, intensive care unit, and operating room were continuously observed. Assessed variables of interest were time allocation, share of direct patient contact, and simultaneous activities. Inter-rater agreement of Kappa = .71 points to good reliability of the instrument.ResultsHospital physicians spent 25.5% of their time at work in direct contact with patients. Most time was allocated to documentation and conversation with colleagues and nursing staff. Physicians performed parallel simultaneous activities for 17–20% of their work time. Communication with patients, documentation, and conversation with colleagues and nursing staff were the most frequently observed simultaneous activities. Applying logit-linear analyses, specific primary activities increase the probability of particular simultaneous activities.ConclusionPatient-related working time in hospitals is limited. The potential detrimental effects of frequently observed simultaneous activities on performance outcomes need further consideration.

Highlights

Hospital physicians' time is a critical resource in medical care
(2) How much time do hospital physicians spend in direct patient contact? Overall, we found physicians work in direct patient contact for 25.5% of their day shift
We found similar activity patterns to those found in US hospitals: most time was spent in documentation and communication activities with staff and only a fifth of it was dedicated to direct patient care [9]

Summary

Introduction

Hospital physicians' time is a critical resource in medical care. The time spent in direct patient contact – a key principle of effective medical care. Two aspects seem to be especially important in the delivery of medical care: direct physician-patient contact and the burden of simultaneous task performance. Physicians' work satisfaction relates to the time they have for patient interaction [3]. U.S hospital physicians in internal medicine tend to work more time in indirect (56%) than in direct patient care (14%) [5]. Physician work in hospital involves a great deal of multidisciplinary communication and coordination of care [8]. In the U.S, up to 24% of working time is dedicated to communication activities [9], and in Australia a time share of 33% has been observed [10]. In Germany, complaints are often voiced concerning "paperwork", documentation demands, or the allocation of enhanced administrative tasks [e.g. [11,12]]

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