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Research Letter |

Intern and Resident Workflow Patterns on Pediatric Inpatient Units A Multicenter Time-Motion Study

Amy J. Starmer, MD, MPH1; Lauren Destino, MD2; Catherine S. Yoon, MS3; Christopher P. Landrigan, MD, MPH1,3
[+] Author Affiliations
1Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
2Division of Pediatric Hospital Medicine, Department of Pediatrics, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Stanford, California
3Center for Patient Safety Research, Division of General Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Pediatr. 2015;169(12):1175-1177. doi:10.1001/jamapediatrics.2015.2471.
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This study describes the proportion of time spent by residents in direct care, indirect care activities, and education across 9 pediatric institutions.

As resident-physician work hours have decreased, and patient complexity1 and hospital documentation2 have concurrently increased, concerns have mounted about the time residents have available for education and face-to-face patient care. Single-center internal medicine studies have found that 12% of trainee time is spent with patients vs 40% in front of the computer.3,4 To our knowledge, no multicenter studies have evaluated this issue in any specialty, including pediatrics. We sought to quantify the proportion of time spent by residents in direct care, indirect care activities, and education across 9 pediatric institutions.

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Figure.
Activity Distribution by Category, Interns and Residents Combined (Percentage of Time per 24 Hours)

Major activity categories included subactivities as follows: waiting for something to respond or arrive (computer, paper, patient, telephone), looking for items or people (colleague, consultant, nurse, patient, supplies, telephone, computer, or patient medical record information), paper-write (writing notes on the printed handoff document; handwritten patient notes, orders, or prescriptions), paper-read (reviewing printed handoff document or part of patient record printed on paper, reading reference materials), education (formal education such as grand rounds or didactic lectures, informal medical education such as learning about a disease process during patient rounds, or patient service learning such as learning how to order a test in the electronic medical record, teaching medical students or residents medical information or patient service activities), telephone (answering or reading pager, paging colleague, getting results, scheduling a test/appointment, telephone call with patient/family members, physicians, nurses, medical students, other staff, or personal telephone calls), patient/family contact (taking patient history, casual conversation, physical examination, explaining the plan of care, educating patient, obtaining consent, discussing advance directives, or conducting medical procedures), personal (eating, sleeping, idle, walking, restroom, talking, personal texting/mobile telephone use, in call room, or donning contact precautions), computer-write (typing into the handoff document, email, sending a text page, writing patient notes, discharge summaries, orders, prescriptions, or incident reports), computer-read (reviewing computerized sign-out, patient record, electrocardiograms, chest radiography, or other patient information; reading email, reference articles, or other online reference material), and interprofessional communication (giving or receiving sign-out; listening to patient presentations or communicating with nurses, medical students, physicians, other staff, or multiple people).

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