title: Cardiologists' workflow in small to medium-sized German hospitals: an observational work analysis.
abstract: OBJECTIVE
  Due to recent changes in national health policy and a subsequent increase in clinicians' workload, medical residents in Germany feel that the growing burden of documentation duties leaves too little time for direct patient care. Thus, to describe the daily workflow in cardiology wards with more accuracy, this real-time observational study detailed all tasks performed by resident cardiologists during daily shifts at German hospitals.
  
  
  METHODS
  Daily routines of 20 resident cardiologists at four German hospitals were observed and recorded in real time during the study period from September 2009 to January 2010. Each participant was shadowed during three entire day shifts by an observer, who recorded all tasks performed by the cardiologist.
  
  
  RESULTS
  During the study period, 60 workdays (512 h) of observation took place. On average, doctors worked 08:31 h per day (SD = 00:32 h). Most time was spent on meetings (2:51 h), on administration duties (1:22 h), on ward rounds and admission to hospital (0:42 h) and on breaks (0:30 h). Doctors were interrupted every 16 min and spent 16.20% of each workday multitasking.
  
  
  CONCLUSIONS
  Ward rounds, meetings and administrative duties took up two-thirds of an average workday. Little time was spent on direct patient care relative to other clinical tasks such as paperwork and management. High rates of interruptions and multitasking were found. As the medical workforce is valuable, changes in the organization of workflow should be made in order to minimize residents' administrative duties and paperwork; thus, cardiologists' job satisfaction might increase.
authors.affiliation: Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Free University and Humboldt University, Berlin, Germany. Stefanie.mache@charite.de
authors.forename: Stefanie
authors.initials: S
authors.lastname: Mache
authors.forename: Dorothea
authors.initials: D
authors.lastname: Busch
authors.forename: Karin
authors.initials: K
authors.lastname: Vitzthum
authors.forename: Bianca
authors.initials: B
authors.lastname: Kusma
authors.forename: Burghard F
authors.initials: BF
authors.lastname: Klapp
authors.forename: David A
authors.initials: DA
authors.lastname: Groneberg
mesh_terms: D000328:Adult; D016507:Cardiology Service, Hospital; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006276:Health Facility Size / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007396:Internship and Residency; D007588:Job Satisfaction; D008297:Male; D005791:Patient Care / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013997:Time Factors; D017748:Time Management; D013996:Time and Motion Studies; D057188:Workflow; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data*