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


METHODS
35 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.


RESULTS
Hospital 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.


CONCLUSIONS
Patient-related working time in hospitals is limited. The potential detrimental effects of frequently observed simultaneous activities on performance outcomes need further consideration.
Weigl
Matthias
M
Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany. matthias.weigl@med.uni-muenchen.de
Müller
Andreas
A
Zupanc
Andrea
A
Angerer
Peter
P
D003627:Data Interpretation, Statistical; D013502:General Surgery / Q000592:standards; D005858:Germany; D006745:Hospital Bed Capacity, 300 to 499; D006773:Hospitals, Municipal; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine / Q000592:standards; D019370:Observation / Q000379:methods; D010817:Physician-Patient Relations; D013996:Time and Motion Studies; D014940:Work Schedule Tolerance; D000078329:Workforce