A time-motion study of ICU workflow and the impact of strain

Yosefa Hefter, Purnema Madahar, Lewis Eisen, Michelle Ng Gong

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: Understanding ICU workflow and how it is impacted by ICU strain is necessary for implementing effective improvements. This study aimed to quantify how ICU physicians spend time and to examine the impact of ICU strain on workflow. Design: Prospective, observational time-motion study. Setting: Five ICUs in two hospitals at an academic medical center. Subjects: Thirty attending and resident physicians. Interventions: None. Measurements and Main Results: In 137 hours of field observations, the most time - 84 hours (62% of total observation time) - was spent on professional communication. Reviewing patient data and documentation occupied a combined 52 hours (38%), whereas direct patient care and education occupied 24 hours (17%) and 13 hours (9%), respectively. The most frequently used tool was the computer, used in tasks that occupied 51 hours (37%). Severity of illness of the ICU on day of observation was the only strain factor that significantly impacted work patterns. In a linear regression model, increase in average ICU Sequential Organ Failure Assessment was associated with more time spent on direct patient care (β = 4.3; 95% CI, 0.9-7.7) and education (β = 3.2; 95% CI, 0.7-5.8), and less time spent on documentation (β = -7.4; 95% CI, -11.6 to -3.2) and on tasks using the computer (β = -7.8; 95% CI, -14.1 to -1.6). These results were more pronounced with a combined strain score that took into account unit census and Sequential Organ Failure Assessment score. After accounting for ICU type (medical vs surgical) and staffing structure (resident staffed vs physician assistant staffed), results changed minimally. Conclusion: Clinicians spend the bulk of their time in the ICU on professional communication and tasks involving computers. With the strain of high severity of illness and a full unit, clinicians reallocate time from documentation to patient care and education. Further efforts are needed to examine system-related aspects of care to understand the impact of workflow and strain on patient care.

Original languageEnglish (US)
Pages (from-to)1482-1489
Number of pages8
JournalCritical Care Medicine
Volume44
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Time and Motion Studies
Workflow
Patient Care
Documentation
Patient Education
Linear Models
Communication
Observation
Organ Dysfunction Scores
Physicians
Physician Assistants
Censuses
Education

Keywords

  • computer systems
  • delivery of health care
  • intensive care units
  • medical education
  • time and motion studies
  • workflow

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

A time-motion study of ICU workflow and the impact of strain. / Hefter, Yosefa; Madahar, Purnema; Eisen, Lewis; Gong, Michelle Ng.

In: Critical Care Medicine, Vol. 44, No. 8, 01.08.2016, p. 1482-1489.

Research output: Contribution to journalArticle

Hefter, Yosefa ; Madahar, Purnema ; Eisen, Lewis ; Gong, Michelle Ng. / A time-motion study of ICU workflow and the impact of strain. In: Critical Care Medicine. 2016 ; Vol. 44, No. 8. pp. 1482-1489.
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