title: A work time study analysing differences in resource use between psychiatric inpatients.
abstract: OBJECTIVE
  Judgement about the adequacy of reimbursement schemes requires an understanding of differences in resource use between patient groups. The aim of this study was to analyse staff time allocation of psychiatrists, psychologists and nurses in inpatient mental health care and to use these data to analyse differences in per diem resource use between patient groups.
  
  
  METHODS
  A self-reporting work-sampling study was carried out at a psychiatric teaching hospital. All of 36 psychiatrists, 23 psychologists and 106 nurses involved in clinical care during the study period participated in a two-week measurement of their work time.
  
  
  RESULTS
  A total of 20,380 observations were collected, representing about 10,190 h of work or 6.2 full-time-equivalent years. The average resource use in minutes of staff time per patient day was 227 min, representing 138 <euro> of staff costs. The most resource intensive care was provided at the Psychiatric Intensive Care Unit and for geriatric patients with 334 and 266 min per patient day (192 and 162 <euro>), respectively. The least resource intensive care was provided for patients with substance-related disorders (197 min, 116 <euro>). Substantial shares of clinical work time were dedicated to tasks without patient contact (58 %). Nursing time was the main driver of total resource use, representing 70 % of staff time and 60 % of costs.
  
  
  CONCLUSIONS
  Presented differences in per diem resource use should inform discussions about the adequacy of reimbursement schemes. Tasks in the absence of the patient, such as documentation and administration, should be reduced to free resources for direct patient care.
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research, Centre for the Economics of Mental and Physical Health, King's College London, London, UK, jan.wolff@kcl.ac.uk.
authors.forename: Jan
authors.initials: J
authors.lastname: Wolff
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.forename: Mathias
authors.initials: M
authors.lastname: Berger
authors.forename: Anita
authors.initials: A
authors.lastname: Patel
authors.forename: Christian
authors.initials: C
authors.lastname: Ackermann
authors.forename: Katja
authors.initials: K
authors.lastname: Gerhardt
authors.forename: Claus
authors.initials: C
authors.lastname: Normann
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D005260:Female; D005858:Germany; D006295:Health Resources / Q000145:classification / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011445:Prospective Payment System / Q000706:statistics & numerical data; D011568:Psychiatric Nursing / Q000706:statistics & numerical data; D011570:Psychiatry / Q000706:statistics & numerical data; D040841:Resource Allocation / Q000706:statistics & numerical data*; D057566:Self Report; D013996:Time and Motion Studies