Education, Teaching, and Quality Improvement |

A Time and Motion Study of ICU Resident Work Practice in the Era of the Electronic Medical Record (EMR) FREE TO VIEW

William Marino
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Coney Island Hospital, Brooklyn, NY

Chest. 2015;148(4_MeetingAbstracts):457A. doi:10.1378/chest.2270853
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SESSION TITLE: Education & Simulation Poster Discussion

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Sunday, October 25, 2015 at 04:30 PM - 05:30 PM

PURPOSE: Since the advent of the EMR a number of investigations have been carried out which examine the effect of the EMR on medical education. The majority of these have been performed on resident behavior in general inpatient care settings and have reported generally negative effects on resident education with the majority of residents reporting spending more time at the computer terminal than either with patients or in performing non-documentation related patient care activities. This study was carried out in order to evaluate whether this phenomenon extends to care and resident education in the intensive care unit.

METHODS: Two single day time and motion worksheets were completed by each resident and fellow rotating through the medical ICU of this institution during a three-month period. Time spent in writing notes, entering orders, rounding, performing and learning procedures, interacting with patients and families, and in educational activities was collected and analyzed.

RESULTS: 38 time and motion sheets were completed by 12 residents and two critical care fellows during the three-month period. The average workday was nine hours with time off consistent with RRC requirements. The largest part of each workday (30%) was spent in documentation. This was followed in magnitude by patient interaction (25%) and computer order entry (20%). Educational activities including didactic teaching, bedside teaching and instruction in the performance of procedures accounted for the remaining 25% of the workday.

CONCLUSIONS: Computer workstation activities comprised 50% of the resident’s work day. Direct patient care and educational activities constituted the remaining 50% of the day. The relative amounts of time spent in these pursuits are similar to those reported in studies of residents working in noncritical inpatient settings. This finding and the observation that all current EMR systems have numerous required fields in documentation and multiple required steps in order entry, all of which are time consuming, support the generalizability of these findings.

CLINICAL IMPLICATIONS: Any EMR used by a teaching institution should be carefully evaluated for its time efficiency, especially with regard to note and order entry before requiring residents to spend their time navigating it during this crucial period of their training.

DISCLOSURE: The following authors have nothing to disclose: William Marino

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