Systematic Review of Hospital Time‐Motion Literature

1Northwestern University, Chicago, IL
2Northwestern University, Chicago, IL
3Northwestern University, Chicago, IL
4Northwestern University, Chicago, IL
5Northwestern University, Chicago, IL

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 98

Background:

Time‐motion studies have been used since the early 20th century to provide minute‐by‐minute accounts of how time is spent in factories and office settings alike. More recently, time‐motion methodology has been used in the hospital setting. We undertook a systematic review of published time‐motion studies performed in the hospital setting.

Methods:

We searched MEDLINE, EMBASE, EMBASE Classic, PsyclNFO, Cochrane Library, CINAHL, and Web of Science between 1965 and July of 2008 using the MESH search terms “task performance and analysis,” “time and motion studies,” “work simplification,” “time management,” and “systems analysis” combined with either “work/academic medical centers,” “hospital units,” and “hospitals,” or “medical staff,” “nurses,” “nursing staff,” and “physicians. We identified studies meeting the following criteria: English‐language articles evaluating physicians, performed on a hospital floor/ward (not outpatient within the hospital), and explicitly using direct observation or time‐motion methodology. A total of 12 articles met these criteria, and a review of reference lists and consultation with experts yielded an additional 4 studies, for a total of 16. Each article was reviewed by 2 independent reviewers using a standardized data collection form.

Results:

All 16 studies evaluated physicians in teaching hospitals. Nine of the 16 articles reported on studies undertaken with the goal of describing how physicians spend their time; 8 of these 9 included residents in their samples, 4 included attending physicians, and 1 included nurses. Four of the 16 articles reported on studies that compared groups from different intern programs, residency rotations, hospital types, or shifts. The remaining 3 of the 16 articles attempted to quantify the amount of time physicians spent on tasks that could be performed by nonphysician staff. Only 2 articles evaluated hospitalists, and we found no articles studying hospitalists in community, nonteaching settings. Methodology varied; 11 studies collected data with stopwatch and paper‐and‐pencil form, 3 used handheld computer systems, and 2 did not describe their methods. The total amount of time subjects were observed averaged 208 hours (range: 50–442 hours), and the number of subjects averaged 16 (range: 2‐42). Median time observed per subject was 12 hours (range: 2.5‐113.5 hours). Three articles reported recording multitasking, and 4 reported recording interruptions.

Conclusions:

The articles we reviewed mostly describe studies designed to provide an accurate picture of a physician's day in the hospital, primarily residents in the teaching setting. Given the necessity for multitasking by hospitalists, better documentation of its frequency and impact is needed. Additionally, the effect of interruptions needs evaluation. Finally, because most hospitalists practice in community hospitals, evaluation of differences from academic facilities is also needed.

Author Disclosure:

M. Tipping, none; V. Forth, none; D. Magill, none; K. Englert, none; M. Williams, Society of Hospital Medicine, Editor.

To cite this abstract:

Tipping M, Forth V, Magill D, Englert K, Williams M. Systematic Review of Hospital Time‐Motion Literature. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 98. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/systematic-review-of-hospital-timemotion-literature/. Accessed August 23, 2019.

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