Time analysis of a general medicine service: results from a random work sampling study

Abstract

Objective: To describe a novel method of time analysis for health care settings by quantifying internal medicine housestaff's work activities and contacts.

Design: Observational work sampling study based on random sampling technique.

Setting: General medicine service in a university hospital.

Participants: All housestaff (18 interns, 18 residents) rotating through the general medicine service during a 12-week period.

Main outcome measures: Proportion of time spent doing 22 work activities and proportion of time spent with 13 work contacts, reported separately for interns and residents and for on-call days and off-call days.

Results: The authors sampled 6,599 unique time observations (3,533 from on-call days, 3,066 from off-call days) during 193 housestaff workdays. The housestaff spent a majority of their time engaged in direct patient care activities (81% of the interns' workdays, and 64.5% of the residents' workdays), primarily in patient evaluation and follow-up (48% of the interns' and 39% of the residents' workdays). Compared with the interns, the residents spent relatively more time in direct educational activities (conferences, reading, teaching): 27% of the residents' workdays versus 10% of the interns' workdays. Analysis of work contacts showed that the housestaff spent a large portion of the workday alone: 27% of the residents' and 34% of the interns' workdays. The housestaff also spent a large portion of the workday with attending physicians: 23% of the residents' and 11% of the interns' workdays. This translates into 21 hours/week of attending supervision for the residents and 10 hours/week for the interns.

Conclusions: Using random work sampling, the authors found that the vast majority of the houseofficer's workday was spent in direct patient care. This method of time analysis may be used to describe housestaff training and supervision, as well as to evaluate administrative interventions designed to change housestaff work experience.