Hospitalist Time Usage and Cyclicality: Opportunities to Improve Efficiency
Hospitalist Time Usage and Cyclicality: Opportunities to Improve Efficiency
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DOI：
10.1002/jhm.613
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发表时间：
2010-07-01
影响因子：
2.6
通讯作者：
Flanders, Scott A.
中科院分区：
文献类型：
--
作者：
Kim, Christopher S.;Lovejoy, William;Flanders, Scott A.
背景：学术医疗中心(AMC)的常驻劳动力有限。许多AMC增加了对非住院服务医院的使用，以管理临床数量的持续增长。为了优化他们在医院的时间，了解住院医生的工作流程是很重要的。设计：我们对住院医生在我们医院的三种轮班(白班、轮班和夜班)中携带入院寻呼机进行了时间运动研究。设置：中西部的第三级学术医疗中心。结果：住院医生将15%的时间用于直接患者护理，三分之二的时间用于间接患者护理。在间接活动中，通信和文件占主导地位。出差占住院医生时间的7%以上。在换班时，间接病人护理的高峰，紧随其后的是直接病人护理的高峰。结论：在我们的AMC，间接病人护理活动占入院患者住院时间的大部分，这一次以病历和沟通为主。旅行花费了住院医生很大一部分时间。全天进行的活动也具有周期性，这可能会导致患者延误，并对支持服务造成变化无常。为了有效地管理住院量的进一步增长，资产管理公司需要有针对性的服务和系统性的改进。《医院医学杂志》2010；5：329-334。(C)2010年医院医学会。
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.DESIGN: 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).SETTING: 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. Journal of Hospital Medicine 2010;5:329-334. (C) 2010 Society of Hospital Medicine.