Abstract

Purpose: Time and motion studies have been used to discover how much time different types of healthcare professionals spend with patients and doing other tasks. However, the majority of such studies are done in the outpatient setting. Most are limited to using either surveys subject to recall bias or human observers. Our goal is to measure the amount of time physicians, nurses, and critical support staff spend in direct patient contact in a medical intensive care unit using a novel method not reliant on self-report or observation. Methods: We used a mote-based sensor network to electronically record contacts among healthcare workers and patients under their care in a 20-bed intensive care unit for a 10-day period covering both day and night shifts. Results: For physicians, 14.73% (17.96%) of the time they were detected by the network on the unit during the day shift (or night shift) was spent in the patient rooms, while 40.63% (30.09%) was spent in the physician work room. The remainder of their time was spent elsewhere. For nurses, 32.97% (32.85%) of their time was spent in patient rooms, and 11.34% (11.79%) of time was spent just outside patient rooms. They spent 11.58% (13.16%) of their time at the nurses’ station and 23.89% (24.34%) elsewhere in the unit. For patients, we found that care time, defined as time with at least one healthcare worker in an ICU room, during day shifts and (night shifts) were as follows: 13.11% (9.90%) with physicians, 86.14% (88.15%) with nurses, and 8.14% (7.52%) with critical support (e.g. respiratory therapists, pharmacists). Conclusions: Physicians, nurses, and critical support staff spend very little of their time in direct patient contact in an intensive care unit, similar to observations in the outpatient setting and inpatient hospital ward. Not surprisingly, nurses spent far more time with patients than physicians. Additionally, physicians spent more than twice as much time in the physician work room, where electronic medical record review and documentation occurs, than they spent with all of their patients combined. Clinical implications: While the idea that physicians spend a relatively sparse amount of time at the patient’s bedside is not new, the implications of such are growing exponentially. Future studies utilizing our methods could be used to look for relationships between direct patient contact and a number of variables such as outcomes, patient and physician satisfaction, length of stay, and objective measures of physician education.