title: A time-motion study of residents and medical students performing patient discharges from general internal medicine wards: a disjointed, interrupted process.
abstract: Patients are at high risk for adverse events after discharge from a hospital admission. As a critical and often time-consuming aspect of care for hospitalized patients, the purpose of this study was to describe the physician time, events and workflow in performing a patient discharge. On General Internal Medicine (GIM) wards at two academic medical centers in Toronto, a time-motion study was performed on 11 residents and 2 medical students performing 32 patient discharges. Using a paper data collection tool, a research associate aimed to capture the distribution of activities and the nature and frequency of workflow interruptions during patient discharges from the perspective of resident and medical student housestaff. Thirty-two GIM patient discharges by the 13 housestaff were observed over a period of 116 h. Discharges required 69.2 ± 41.2 min of housestaff-dedicated time to complete, but spanned over a mean 3.7 h from start to finish. On average, 32.8 min (47.3%) of time spent on discharges was dedicated to documentation activities; 13.5 min (19.6%) to direct patient communication; 10.8 min (15.6%) to communication with other clinicians and providers; 6.5 min (9.4%) to arranging outpatient care; 5.7 min (8.2%) to time in transit and waiting. For each discharge, housestaff were interrupted a mean of 5.5 times and switched tasks 8.7 times. During the discharge process, housestaff mainly dedicated themselves to documentation activities and focused minimally on direct patient communication. Clinicians were also found to experience several workflow inefficiencies and interruptions. The present study can be used to identify opportunities to improve and further focus efforts in characterizing this dynamic process.
authors.affiliation: OpenLab, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada.
authors.forename: Arjun
authors.initials: A
authors.lastname: Sharma
authors.affiliation: OpenLab, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada.
authors.forename: Vivian
authors.initials: V
authors.lastname: Lo
authors.affiliation: Division of General Internal Medicine, University Health Network, Toronto, ON, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Lapointe-Shaw
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Soong
authors.affiliation: Division of General Internal Medicine, University Health Network, Toronto, ON, Canada.
authors.forename: Peter Eugene
authors.initials: PE
authors.lastname: Wu
authors.affiliation: OpenLab, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada. robert.wu@uhn.ca.|Division of General Internal Medicine, University Health Network, Toronto, ON, Canada. robert.wu@uhn.ca.|Department of Medicine, University of Toronto, Toronto, ON, Canada. robert.wu@uhn.ca.
authors.forename: Robert Clark
authors.initials: RC
authors.lastname: Wu
mesh_terms: D006801:Humans; D007388:Internal Medicine / Q000379:methods* / Q000592:standards; D007396:Internship and Residency; D009864:Ontario; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data; D010362:Patients' Rooms; D013337:Students, Medical / Q000523:psychology / Q000706:statistics & numerical data*; D013996:Time and Motion Studies; D000078329:Workforce
keywords: Discharge planning; Hospital care; Time-motion study; Transitions; Workflow