Abstract
Background
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.
Methods
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.
Results
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).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: April 09, 2018
Footnotes
Funding: The data collection for this project was supported in part by a cooperative agreement from the Centers for Disease Control and Prevention (CDC). The CDC had no role in study design, analysis, interpretation of data, writing or deciding to submit the manuscript.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
