What do ICU doctors do? A multisite time and motion study of the clinical work patterns of registrars.

OBJECTIVE

To quantify the time that intensive care unit registrars spend on different work tasks with other health professionals and patients and using information resources, and to compare them with those of clinicians in general wards and the emergency department (ED).

DESIGN, SETTING AND PARTICIPANTS: A prospective, observational time-and-motion study of two ICUs with a total of 71 beds at two major teaching hospitals in Sydney. Twenty-six registrars were observed between 08:00 and 18:00 on weekdays for a total of 160.52 hours.

MAIN OUTCOME MEASURES

Proportions of time spent on different tasks, using specific information resources, working with other health professionals and patients, and rates of multitasking and interruptions.

RESULTS

A total of 12 043 distinct tasks were observed. Registrars spent 69.2% of time working at patients' bedsides, 49.6% in professional communication and 39.0% accessing information resources. Half of their time (53.8%) was spent with other ICU doctors and 29.2% with nurses. Compared with doctors and nurses on general wards, and doctors in the ED, ICU registrars were more likely to multitask (40.1 times/hour [24.4% of their time]). ICU registrars had a higher interruption rate than ward clinicians, (4.2 times/hour), but a lower rate than ED doctors.

CONCLUSIONS

Face-to-face communication and information seeking consume a vast proportion of ICU registrars' time. Multitasking and handling frequent interruptions characterise their work, and such behaviours may create an increased risk of task errors. Electronic clinical information systems may be particularly beneficial in this information-rich environment.