How hospitalists spend their time: insights on efficiency and safety.
BACKGROUND
Despite the dramatic growth of hospitalists, no studies have evaluated the type and frequency of activities that hospitalists perform. To evaluate the types and frequency of activities that hospitalists perform during routine work, we conducted a time-motion study of hospitalist physicians at our institution.


METHODS
A research assistant shadowed hospitalist physicians for 3- to 5-hour periods. Observation periods were distributed in order to sample all parts of a typical day of a hospitalist, including both admitting and nonadmitting periods. Activities were recorded on a standardized data collection form in 1-minute intervals. Incoming pages were recorded as well.


RESULTS
Ten hospitalists were shadowed by a single research assistant for a total of 4467 minutes. Hospitalists spent 18% of their time on direct patient care, 69% on indirect patient care, 4% on personal activities, and 3% each on professional development, education, and travel. Communication accounted for 24% of the total minutes. Multitasking, performing more than one activity at the same time, was done 21% of the time. Hospitalists received an average of 3.4 +/- 1.5 pages per hour.


CONCLUSIONS
Hospitalists spent most of their time on indirect patient care activities and relatively little time on direct patient care. Hospitalists spent a large amount of time on communication, underscoring the need for hospitalists to have outstanding communication skills and systems that support efficient communication. Multitasking and paging interruptions were common. The inherent distraction caused by interruptions and multitasking is a potential contributor to medical error and warrants further study.
O'Leary
Kevin J
KJ
Division of General Internal Medicine, Feinberg School of Medicine of Northwestern University, Chicago, Illinois 60611, USA. koleary@nmff.org
Liebovitz
David M
DM
Baker
David W
DW
D000328:Adult; D017598:Efficiency, Organizational; D005260:Female; D020445:Hospitalists / Q000379:methods*; D006801:Humans; D008297:Male; D005791:Patient Care / Q000009:adverse effects / Q000379:methods; D010817:Physician-Patient Relations; D012449:Safety; D013996:Time and Motion Studies