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Residents spend triple the time on computer work they do on direct patient care

To help residents allocate their time better and increase the effectiveness of practice, further improvements to electronic medical records and work organization are necessary in the hospital setting, according to a Swiss study published in Annals of Internal Medicine.

“The structure of a resident's workday has … changed dramatically in recent decades, with limitations on hours worked per week, wide implementation of electronic medical records (EMRs), and a growing volume of clinical data and administrative tasks,” Nathalie Wenger, MD, from Lausanne University Hospital in Switzerland, and colleagues wrote.

A recent study found that physicians spend nearly 50% of their time on EMR and desk work; however, there is little current evidence on how computer use affects internal medicine resident’s time allocation, according to Wenger and colleagues.

The researchers conducted a time and motion study to evaluate how residents spend their time during day and evening hospital shifts. From May to July 2015, they studied 36 Swiss internal medicine residents with an average of 29 months of postgraduate training. Trained observers collected data on the residents’ activities, categorized as either directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks or transition. The observers also documented whether a patient or colleague was present and whether a computer or telephone was used during each activity. They recorded data for 66 shifts (49 day shifts and 17 evening shifts) consisting of 696.7 hours of observation. Nine residents were only observed once due to external factors, such as vacation time.

Data indicated that residents worked approximately 1.6 hours longer than their scheduled 10-hour daily shift. Residents spent 52.4% of their time on activities indirectly related to patients compared to 28% of their time on activities directly related to patients during day shifts. This equated to an average of 1.7 hours per day with patients, 5.2 hours using computers and 13 minutes doing both. After 6 p.m. was the busiest time for computer use.

“Although information technologies are improving, EMRs have thus far failed to fulfill their promise in hospital practice,” Wenger and colleagues wrote.

“The large amount of time dedicated to computer use or other activities not centered on the patient could lead to dissatisfaction of residents due to the limited medical value of such activities and could also increase the risk for burnout, [as well as inappropriate prescribing and medical malpractice],” they concluded. “Thus, our results suggest the need to rethink residents' work organization to fit the digital age.” – by Alaina Tedesco

Disclosure: Wenger and colleagues report primary funding from Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.