Clinical Research Study| Volume 131, ISSUE 8, P972.e9-972.e15, August 2018

Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network



      Time and motion studies have been used to investigate how much time various health care professionals spend with patients as opposed to performing other tasks. However, the majority of such studies are done in outpatient settings, and rely on surveys (which are subject to recall bias) or human observers (which are subject to observation bias). Our goal was to accurately measure the time physicians, nurses, and critical support staff in a medical intensive care unit spend in direct patient contact, using a novel method that does not rely on self-report or human observers.


      We used a network of stationary and wearable mote-based sensors to electronically record location and contacts among health care workers and patients under their care in a 20-bed intensive care unit for a 10-day period covering both day and night shifts. Location and contact data were used to classify the type of task being performed by health care workers.


      For physicians, 14.73% (17.96%) of their time in the unit during the day shift (night shift) was spent in patient rooms, compared with 40.63% (30.09%) spent in the physician work room; the remaining 44.64% (51.95%) of their time was spent elsewhere. For nurses, 32.97% (32.85%) of their time on unit was spent in patient rooms, with an additional 11.34% (11.79%) spent just outside patient rooms. They spent 11.58% (13.16%) of their time at the nurses' station and 23.89% (24.34%) elsewhere in the unit. From a patient's perspective, we found that care times, defined as time with at least one health care worker of a designated type in their intensive care unit room, were distributed as follows: 13.11% (9.90%) with physicians, 86.14% (88.15%) with nurses, and 8.14% (7.52%) with critical support staff (eg, respiratory therapists, pharmacists).


      Physicians, nurses, and critical support staff spend very little of their time in direct patient contact in an intensive care unit setting, similar to reported observations in both outpatient and inpatient settings. Not surprisingly, nurses spend far more time with patients than physicians. Additionally, physicians spend more than twice as much time in the physician work room (where electronic medical record review and documentation occurs) than the time they spend with all of their patients combined.


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        • Alromaihi D.
        • Godfrey A.
        • Dimoski T.
        • Gunnels P.
        • Scher E.
        • Baker-Genaw K.
        Internal medicine residents' time study: paperwork versus patient care.
        J Grad Med Educ. 2011; 3: 550-553
        • Lurie N.
        • Rank B.
        • Parenti C.
        • Woolley T.
        • Snoke W.
        How do house officers spend their nights? A time study of internal medicine house staff on call.
        N Engl J Med. 1989; 320: 1673-1677
        • Moore S.S.
        • Nettleman M.D.
        • Beyer S.
        • et al.
        How residents spend their nights on call.
        Acad Med. 2000; 75: 1021-1024
        • Gottschalk A.
        • Flocke S.A.
        Time spent in face-to-face patient care and work outside the examination room.
        Ann Fam Med. 2005; 3: 488-493
        • Hollingsworth J.C.
        • Chisholm C.D.
        • Giles B.K.
        • Cordell W.H.
        • Nelson D.R.
        How do physicians and nurses spend their time in the emergency department?.
        Ann Emerg Med. 1998; 31: 87-91
        • Dresselhaus T.R.
        • Luck J.
        • Wright B.C.
        • Spragg R.G.
        • Lee M.L.
        • Bozzette S.A.
        Analyzing the time and value of housestaff inpatient work.
        J Gen Intern Med. 1998; 13: 534-540
        • Mador R.L.
        • Shaw N.T.
        The impact of a Critical Care Information System (CCIS) on time spent charting and in direct patient care by staff in the ICU: a review of the literature.
        Int J Med Inform. 2009; 78: 435-445
        • Polgreen P.M.
        • Hlady C.S.
        • Severson M.A.
        • Segre A.M.
        • Herman T.
        Method for automated monitoring of hand hygiene adherence without radio-frequency identification.
        Infect Control Hosp Epidemiol. 2010; 31: 1294-1297
        • Patwari N.
        • Hero A.O.
        • Perkins M.
        • Correal N.S.
        • O'Dea R.J.
        Relative location estimation in wireless sensor networks.
        IEEE Trans Signal Proc. 2003; 51: 2137-2148
        • Monsalve M.N.
        • Pemmaraju S.V.
        • Thomas G.W.
        • Herman T.
        • Segre A.M.
        • Polgreen P.M.
        Do peer effects improve hand hygiene adherence among healthcare workers?.
        Infect Control Hosp Epidemiol. 2014; 35: 1277-1285
        • O'Leary K.J.
        • Liebovitz D.M.
        • Baker D.W.
        How hospitalists spend their time: insights on efficiency and safety.
        J Hosp Med. 2006; 1: 88-93
        • Carroll K.
        • Iedema R.
        • Kerridge R.
        Reshaping ICU ward round practices using video-reflexive ethnography.
        Qual Health Res. 2008; 18: 380-390
        • Mechanic D.
        Physician discontent: challenges and opportunities.
        JAMA. 2003; 290: 941-946
        • Ammenwerth E.
        • Spotl H.P.
        The time needed for clinical documentation versus direct patient care. A work-sampling analysis of physicians' activities.
        Methods Inf Med. 2009; 48: 84-91
        • Grembowski D.
        • Ulrich C.M.
        • Paschane D.
        • et al.
        Managed care and primary physician satisfaction.
        J Am Board Fam Pract. 2003; 16: 383-393
        • Gross D.A.
        • Zyzanski S.J.
        • Borawski E.A.
        • Cebul R.D.
        • Stange K.C.
        Patient satisfaction with time spent with their physician.
        J Fam Pract. 1998; 47: 133-137
        • Chaitin E.
        • Stiller R.
        • Jacobs S.
        • Hershl J.
        • Grogen T.
        • Weinberg J.
        Physician-patient relationship in the intensive care unit: erosion of the sacred trust?.
        Crit Care Med. 2003; 31: S367-S372