How Do Residents Spend Their Shift Time? A Time and Motion Study With a Particular Focus on the Use of Computers

Abstract

Purpose: To understand how much time residents spend using computers compared with other activities, and what residents use computers for.

Method: This time and motion study was conducted in June and July 2010 at NewYork-Presbyterian/Columbia University Medical Center with seven residents (first-, second-, and third-year) on the general medicine service. An experienced observer shadowed residents during a single day shift, captured all their activities using an iPad application, and took field notes. The activities were captured using a validated taxonomy of clinical activities, expanded to describe computer-based activities with a greater level of detail.

Results: Residents spent 364.5 minutes (50.6%) of their shift time using computers, compared with 67.8 minutes (9.4%) interacting with patients. In addition, they spent 292.3 minutes (40.6%) talking with others in person, 186.0 minutes (25.8%) handling paper notes, 79.7 minutes (11.1%) in rounds, 80.0 minutes (11.1%) walking or waiting, and 54.0 minutes (7.5%) talking on the phone. Residents spent 685 minutes (59.6%) multitasking. Computer-based documentation activities amounted to 189.9 minutes (52.1%) of all computer-based activities time, with 128.7 minutes (35.3%) spent writing notes and 27.3 minutes (7.5%) reading notes composed by others.

Conclusions: The study showed that residents spent considerably more time interacting with computers (over 50% of their shift time) than in direct contact with patients (less than 10% of their shift time). Some of this may be due to an increasing reliance on computing systems for access to patient data, further exacerbated by inefficiencies in the design of the electronic health record.

Figure 1

Aggregated times (in minutes) spent on different activity categories for each participant in the time and motion study, general medicine service, NewYork-Presbyterian/Columbia University Medical Center, June and July 2010. Each row represents a single participant; different shades of gray indicate different activity categories. Notably, in this figure the Computer read/write category does not include the subcategory Documenting (or writing notes), which is presented as a separate category here.

Figure 2

Heat map visualization of the activities captured for each participant in the time and motion study, general medicine service, NewYork-Presbyterian/Columbia University Medical Center, June and July 2010. The x axis shows the timeline of observations, starting from between 7:00 a.m. and 8:00 a.m. and ending between 3:00 p.m. and 9:00 p.m. In the y axis, each row represents a single participant; the rows are grouped by the participants' postgraduate year (interns on top and second- and third-year residents on bottom). Each shaded block represents a captured activity. The length of the blocks on the horizontal timeline represents the duration of the activities. White spaces (see participants 2 and 6) indicate times when participants were called off the floor and reflect a pause in data capture activities. Notably, in this figure the Computer read/write category does not include the subcategory Documenting (or writing notes), which is presented as a separate category here.