J Clin Outcomes Manage
How Canadian hospitalists spend their time -- a work-sampling study within a hospital medicine program in Ontario
Abstract: Background: Despite significant growth of hospital medicine in Canada over the past decade, little is known about the characteristics of hospitalist programs and how they operate. Objective: To understand the type of activities hospitalists perform and the amount of time they spend on performing various tasks. Methods: Over a 2-week period, a trained observer followed 7 hospitalists for 2-hour blocks during 11 shifts. The shifts were chosen to represent various times of day, evening, weekend, and night call shifts. Activities were recorded using data sheets capturing 1-minute increments, allowing for recording of simultaneous tasks. Activity categories were defined a priori. Results: A total of 2070 minutes of observations were recorded. Hospitalists were found to be multitasking during 30% of the time. Direct and indirect patient care was observed in 17% and 66% of the time, respectively. Gathering information, communication, and documentation represented 37%, 34%, and 28% of indirect care. Hospitalists spent 8% of their time on traveling within the hospital and 8% on personal tasks. Conclusion: Canadian hospitalists spend the majority of their time on indirect patient care. Better integrated electronic medical record systems may result in increased efficiency for hospitalists. Additionally, provincial health ministries must consider the amount of time hospitalists spend on nonbillable activities when reviewing inpatient fee codes to ensure sustainable funding mechanisms for hospitalist programs.
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