The relationship between time spent communicating and communication outcomes on a hospital medicine service.

BACKGROUND

Quality care depends on effective communication between caregivers, but it is unknown whether time spent communicating is associated with communication outcomes.

OBJECTIVE

To assess the association between time spent communicating, agreement on plan of care, and patient satisfaction.

DESIGN

Time-motion study with cross-sectional survey.

SETTING

Academic medical center.

PARTICIPANTS

Physicians, patients, and nurses on a hospital medicine service.

MEASUREMENTS

Hospitalists' forms of communication were timed with a stopwatch. Physician-nurse agreement on the plan of care and patient satisfaction with physician communication were assessed via survey.

RESULTS

Eighteen hospitalists were observed caring for 379 patients. On average, physicians spent more time per patient on written than verbal communication (median: 9.2 min. vs. 6.3 min, p<0.001). Verbal communication was greatest with patients (mean time 5.3 min, range 0-37 min), then other physicians (1.4 min), families (1.1 min), nurses (1.1 min), and case managers (0.4 min). There was no verbal communication with nurses in 30% of cases. Nurses and physicians agreed most about planned procedures (87%), principal diagnosis (74%), tests ordered (73%), anticipated discharge date (69%) and least regarding medication changes (59%). There was no association between time spent communicating and agreement on plan of care. Among 123 patients who completed surveys (response rate 32%), time physicians spent talking to patients was not correlated with patients' satisfaction with physician communication (Pearson correlation coefficient = 0.09, p=0.30).

CONCLUSIONS

Hospitalists vary in the amount of time they spend communicating, but we found no association between time spent and either patient satisfaction or nurse-physician agreement on plan of care.