Department of Orthopaedics, Penn State College of Medicine, Hershey, PA.
J Pediatr Orthop. 2021;41(5):319-321. doi: 10.1097/BPO.0000000000001786.
The purpose of this study is to quantify how pediatric orthopaedic surgeons spend time in clinic.
Two pediatric orthopaedic surgeons were individually observed and activities were timed during 3 clinic sessions. One medical student observed and recorded the time using a data collection sheet and a watch. The duration of each clinic session was 4 hours and a new patient was seen every 20 minutes. Data was collected in 7 categories including: time with the patient; time with staff; time listening to the resident presentations, time teaching, time multitasking, time dictating, and time on the electronic medical record (EMR). The number of computer mouse clicks needed to complete each patient encounter was also recorded. The Cerner EMR system was used (Cerner Inc. North Kansas City, MO).
Thirty-six percent of the physician's time was spent on the EMR. Thirty-five percent of time was spent with the patient, 7% was spent dictating, 7% teaching, 5% multitasking, 6% with staff, and 4% listening to resident presentations. Overall, during a 20-minute patient visit, 7.2 minutes was spent on the EMR. During a 4-hour clinic, 87 minutes was spent on the EMR. During a full day of clinic-two 4-hour sessions-173 minutes were spent on the EMR. The average number of computer mouse clicks to complete a patient encounter was 70 (range: 42 to 110). A total of 1680 clicks were needed to see 24 patients in a typical 2 session clinic.
Pediatric orthopaedic surgeons spend more time on the EMR than with patients. About 70 computer mouse clicks are needed per patient encounter. The excessive computer time can diminish the patient-physician relationship. Click fatigue in physicians is real and needs to be resolved by improved EMR technology, utilization of medical scribes, or a return to partial use of paper.
Level IV-an observational study.
本研究的目的是量化小儿矫形外科医生在诊所的工作时间。
对两名小儿矫形外科医生进行了单独观察，并在 3 次就诊期间对活动进行了计时。一名医学生使用数据收集表和手表观察并记录时间。每次就诊持续 4 小时，每 20 分钟看一位新病人。数据收集分为 7 类：与患者在一起的时间；与工作人员在一起的时间；听住院医师报告的时间；教学时间；多任务处理时间；口述时间；电子病历（EMR）时间。完成每位患者就诊所需的计算机鼠标点击次数也被记录下来。使用的是 Cerner EMR 系统（Cerner Inc. North Kansas City，MO）。
医生 36%的时间花在 EMR 上。35%的时间用于与患者交流，7%的时间用于口述，7%的时间用于教学，5%的时间用于多任务处理，6%的时间用于与工作人员交流，4%的时间用于听取住院医师报告。总的来说，在 20 分钟的患者就诊中，有 7.2 分钟用于 EMR。在 4 小时的诊所就诊中，有 87 分钟用于 EMR。在全天的诊所就诊中（两次 4 小时的就诊），有 173 分钟用于 EMR。完成一次患者就诊平均需要点击 70 次鼠标（范围：42 到 110 次）。在典型的两次就诊的诊所中，需要点击 1680 次鼠标才能看 24 位患者。
小儿矫形外科医生在 EMR 上花费的时间多于与患者交流的时间。每位患者就诊大约需要点击 70 次鼠标。过多的计算机时间可能会削弱医患关系。医生的点击疲劳是真实存在的，需要通过改进 EMR 技术、使用医疗抄写员或恢复部分纸质病历来解决。
IV 级-观察性研究。
