title: Hospitalist time usage and cyclicality: opportunities to improve efficiency.
abstract: BACKGROUND
  Academic medical centers (AMCs) have a constrained resident work force. Many AMCs have increased the use of nonresident service hospitalists to manage continued growth in clinical volume. To optimize their time in the hospital, it is important to understand hospitalists' work flow.
  
  
  METHODS
  We performed a time-motion study of hospitalists carrying the admission pager throughout the 3 types of shifts we have at our hospital (day shift, swing shift, and night shift).
  
  
  METHODS
  Tertiary academic medical center in the Midwest.
  
  
  RESULTS
  Hospitalists spend about 15% of their time on direct patient care, and two-thirds of their time on indirect patient care. Of the indirect activities, communication and documentation dominate. Travel demands make up over 7% of a hospitalists' time. There are spikes in indirect patient care, followed closely by spikes in direct patient care, at shift changes.
  
  
  CONCLUSIONS
  At our AMC, indirect patient care activities accounted for the majority of the admitting hospitalists' time spent in the hospital, with documentation and communication dominating this time. Travel takes a significant fraction of hospitalists' time. There is also a cyclical nature to activities performed throughout the day, which can cause patient delays and impose variability on support services. There is a need for both service-specific and systemic improvements for AMCs to efficiently manage further growth in their inpatient volume.
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109-5376, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kim
authors.forename: William
authors.initials: W
authors.lastname: Lovejoy
authors.forename: Michael
authors.initials: M
authors.lastname: Paulsen
authors.forename: Robert
authors.initials: R
authors.lastname: Chang
authors.forename: Scott A
authors.initials: SA
authors.lastname: Flanders
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D003142:Communication; D004282:Documentation; D017598:Efficiency, Organizational; D020445:Hospitalists / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008824:Michigan; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data; D005791:Patient Care; D013996:Time and Motion Studies; D000078329:Workforce