Which made me wonder: What would Brett Favre, the Minnesota Vikings’ future Hall of Fame quarterback, think if he were watching me ply my trade? Which led me to further wonder how far afield Brett Favre’s life would have to be derailed for him to watch me round. Finally, it left me wondering why I don’t spend my time wondering about more productive things.
Anyway, if Brett were to watch one of us, this is what he’d see: The average hospitalist in this study spent only 18% of their time in direct-patient-care activities, including taking a patient history, examining a patient, and meeting with a patient’s family. Eighteen percent! Isn’t seeing patients why I became a doctor?
While it’s more time than Brett Favre spends slinging the pigskin, it’s still an astonishingly low amount of time actually working with patients. Then there’s the “indirect patient care” category (e.g., reviewing tests, writing notes, making orders), where we spend 69% of our day. This is our time in the huddle, so to speak: lots of planning, little action. Further, these academic hospitalists spent 4% of their time on personal activities (e.g., lunch, bathroom breaks), and 3% of their time in each of the following endeavors: professional development (learning, conferences), teaching, and traveling from floor to floor seeing patients.
Another revealing find was that the average hospitalist spent 6% of their time paging other physicians and 7% returning pages from others (the average hospitalist received 3.4 pages an hour). That’s 13% of the day spent on the phone, or waiting for a phone to ring. That’s about 1.5 hours of a typical 12-hour shift. Over the course of a year, that equates to about 300 hours of time (25 shifts) spent in the paging process. If we could find a way to totally remove the paging process from hospital communication, the average hospitalist could accomplish the same amount of work they do now, and take an additional 20-25 days off per year. Perhaps we should wear high-tech helmets—you know, the kind quarterbacks like Brett Favre use to communicate with his coaches on the sidelines.
Efficient Solutions
Before my hospitalists hit me up for wireless communication devices and an extra three weeks of vacation, understand that much of the paging downtime likely is used for multitasking. In fact, in the study, 21% of a hospitalist’s time was spent working on more than one endeavor. Still, my experience tells me that there is a lot of time lost in the paging vortex.
Furthermore, the 3% of time hospitalists spent walking to other floors, 5% spent on discharge paperwork, and 1% of time spent on routine clerical work (did the researchers inadvertently report 1% instead of 10%?) adds up to nearly a tenth of the day that is either wasted, could be automated, or could be completed by ancillary staff.
To be clear, this happens through no fault of individual hospitalists. Rather, it results from the inefficiency of hospital care systems. And if we endeavor to enhance the revenue, efficiency, and satisfaction of our providers, we need to re-engineer our systems to alter that vast expanse of time spent on inactivity and inefficiency. This means adopting new modes of communication, moving toward geographic rounds, and generally retooling our operational inefficiencies.
Short of that, we risk becoming as idle as the NFL—without the cheerleaders. TH
Dr. Glasheen is The Hospitalist’s physician editor.
Reference
- O’Leary KJ, Liebovitz DM, Baker DW. How hospitalists spend their time: insights on efficiency and safety. J Hosp Med. 2006;1(2):88-93.