Paperwork versus patient care: a nationwide survey of residents' perceptions of clinical documentation requirements and patient care

Abstract

Background: The current health care system requires a substantial amount of documentation by physicians, potentially limiting time spent on patient care.

Objective: We sought to explore trainees' perceptions of their clinical documentation requirements and the relationship between time spent on clinical documentation versus time available for patient care.

Methods: An anonymous, online survey was sent to trainees in all postgraduate years of training and specialties in Accreditation Council for Graduate Medical Education-accredited programs.

Results: Over a 2-month time frame, 1515 trainees in 24 specialties completed the survey. Most (92%) reported that documentation obligations are excessive, that time spent with patients has been compromised by this (90%), and that the amount of clinical documentation has had a negative effect on patient care (73%). Most residents and fellows reported feeling rushed and frustrated because of these documentation demands. They also reported that time spent on these tasks decreased their time available for teaching others and reduced the quality of their education. Respondents reported spending more time on clinical documentation than on direct patient care (P < .001).

Conclusions: Trainees' current clinical documentation workload may be a barrier to optimal patient care and to resident and fellow education. Residents and fellows report that clinical documentation duties are onerous, and there is a perceived negative effect on time spent with patients, overall quality of patient care, physician well-being, time available for teaching, and quality of resident education.

FIGURE 1

Medical Versus Surgical Specialty Response Data. Survey questions used a 5-point Likert rating scale. Categorical responses were converted to numeric data as follows: strongly disagree  =  1; disagree  =  2; neither agree nor disagree  =  3; agree  =  4; strongly agree  =  5

FIGURE 2

Amount of Time Spent on Direct Patient Care and Documentation Requirements. Average self-reported time allocation for direct patient care and documentation requirements. Survey questions used an ordered rating scale representing percentage of time spent. Ordered responses were converted to numeric data as follows: 0%–20%  =  1; 21%–40%  =  2; 41%–60%  =  3; 61%–80%  =  4; 81%–100%  =  5

FIGURE 3

Difference Between Current Time Spent and Ideal Time Allotment for Direct Patient Care and Documentation Requirements. Ordered responses were converted to numeric data as follows: 0%–20%  =  1; 21%–40%  =  2; 41%–60%  =  3; 61%–80%  =  4; 81%–100%  =  5