Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties
Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties
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DOI：
10.7326/m16-0961
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发表时间：
2016-12-06
影响因子：
39.2
通讯作者：
Blike, George
中科院分区：
文献类型：
--
作者：
Sinsky, Christine;Colligan, Lacey;Blike, George
背景资料：目的：描述门诊医生的时间是如何分配的，设计：定量的直接观察时间和运动研究（在办公时间内）和自我报告的日记（下班后），设置：美国4个州（伊利诺斯州、新罕布什尔州、弗吉尼亚州和华盛顿）的4个专科门诊。S.家庭医学、内科、心脏病学和骨科的医生被观察了430小时，其中21人还完成了下班后的日记。（直接临床面对面时间、电子健康记录[EHR]和案头工作、行政任务和其他任务）和自我报告的下班后工作。在办公时间内，医生花费27.0%的总时间与患者直接临床面对面，49.2%的时间用于电子病历和案头工作。而在检查室与病人，医生花在直接临床面对面的时间和37.0%的电子病历和案头工作的时间占52.9%。21名完成下班后日记的医生报告说，他们每晚有1到2个小时的下班后工作，主要用于EHR任务。局限性：数据是在自我选择的高性能实践中收集的，可能无法推广到其他环境。描述性研究设计不支持正式的统计比较医生和实践的characteristics.Conclusion：对于每一个小时的医生提供直接的临床面对病人的时间，近2个额外的时间花在电子病历和办公桌上的工作在诊所的一天。在办公时间之外，医生每天晚上还要花1到2个小时的私人时间做额外的计算机和其他文书工作。
Background: Little is known about how physician time is allocated in ambulatory care.Objective: To describe how physician time is spent in ambulatory practice.Design: Quantitative direct observational time and motion study (during office hours) and self-reported diary (after hours).Setting: U.S. ambulatory care in 4 specialties in 4 states (Illinois, New Hampshire, Virginia, and Washington).Participants: 57 U. S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for 430 hours, 21 of whom also completed after-hours diaries.Measurements: Proportions of time spent on 4 activities (direct clinical face time, electronic health record [EHR] and desk work, administrative tasks, and other tasks) and self-reported afterhours work.Results: During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.Limitations: Data were gathered in self-selected, high-performing practices and may not be generalizable to other settings. The descriptive study design did not support formal statistical comparisons by physician and practice characteristics.Conclusion: For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work.