Department of Internal Medicine, University of Iowa, Iowa City.
Department of Epidemiology, University of Iowa, Iowa City; Centro de Investigación para la Gestión Integrada de Desastres Naturales, Santiago, Chile.
Am J Med. 2018 Aug;131(8):972.e9-972.e15. doi: 10.1016/j.amjmed.2018.03.015. Epub 2018 Apr 9.
Time and motion studies have been used to investigate how much time various health care professionals spend with patients as opposed to performing other tasks. However, the majority of such studies are done in outpatient settings, and rely on surveys (which are subject to recall bias) or human observers (which are subject to observation bias). Our goal was to accurately measure the time physicians, nurses, and critical support staff in a medical intensive care unit spend in direct patient contact, using a novel method that does not rely on self-report or human observers.
We used a network of stationary and wearable mote-based sensors to electronically record location and contacts among health care workers and patients under their care in a 20-bed intensive care unit for a 10-day period covering both day and night shifts. Location and contact data were used to classify the type of task being performed by health care workers.
For physicians, 14.73% (17.96%) of their time in the unit during the day shift (night shift) was spent in patient rooms, compared with 40.63% (30.09%) spent in the physician work room; the remaining 44.64% (51.95%) of their time was spent elsewhere. For nurses, 32.97% (32.85%) of their time on unit was spent in patient rooms, with an additional 11.34% (11.79%) spent just outside patient rooms. They spent 11.58% (13.16%) of their time at the nurses' station and 23.89% (24.34%) elsewhere in the unit. From a patient's perspective, we found that care times, defined as time with at least one health care worker of a designated type in their intensive care unit room, were distributed as follows: 13.11% (9.90%) with physicians, 86.14% (88.15%) with nurses, and 8.14% (7.52%) with critical support staff (eg, respiratory therapists, pharmacists).
Physicians, nurses, and critical support staff spend very little of their time in direct patient contact in an intensive care unit setting, similar to reported observations in both outpatient and inpatient settings. Not surprisingly, nurses spend far more time with patients than physicians. Additionally, physicians spend more than twice as much time in the physician work room (where electronic medical record review and documentation occurs) than the time they spend with all of their patients combined.
时间和动作研究已被用于调查不同医疗保健专业人员与患者相处的时间，而不是执行其他任务的时间。然而，大多数此类研究都是在门诊环境中进行的，并且依赖于调查（易受回忆偏差影响）或人类观察者（易受观察偏差影响）。我们的目标是使用一种不依赖于自我报告或人类观察者的新方法，准确测量医疗重症监护病房的医生、护士和关键支持人员与直接患者接触的时间。
我们使用一个由固定和可穿戴 mote 传感器组成的网络，在一个 20 张病床的重症监护病房中，在白天和夜间轮班期间，连续 10 天记录医疗保健工作者和他们所照顾的患者之间的位置和接触情况。位置和接触数据用于对医疗保健工作者执行的任务类型进行分类。
对于医生来说，他们在白天轮班（夜间轮班）的时间中，有 14.73%（17.96%）在病房中，而在医生办公室的时间为 40.63%（30.09%）；其余 44.64%（51.95%）的时间都在其他地方度过。对于护士来说，他们在病房中的时间有 32.97%（32.85%），还有 11.34%（11.79%）的时间在病房外。他们在护士站的时间为 11.58%（13.16%），在病房其他地方的时间为 23.89%（24.34%）。从患者的角度来看，我们发现护理时间（定义为在重症监护病房房间中至少有一名指定类型的医疗保健工作者的时间）分布如下：13.11%（9.90%）为医生，86.14%（88.15%）为护士，8.14%（7.52%）为关键支持人员（如呼吸治疗师、药剂师）。
医生、护士和关键支持人员在重症监护病房环境中与直接患者接触的时间非常少，这与门诊和住院环境中的报告观察结果相似。不出所料的是，护士与患者在一起的时间远远超过医生。此外，医生在医生工作室内（电子病历审查和文件记录发生的地方）花费的时间是他们与所有患者在一起的时间的两倍多。
