ANALYZING THE TIME AND VALUE OF HOUSESTAFF INPATIENT WORK

OBJECTIVE: determine time allocation and the perceived value to educat ion and patient care of the weekday activities of internal medicine ho usestaff on inpatient rotations and to compare the work activities of interns and residents. DESIGN: An observational study. We classified a ctivities along five dimensions (association, location, activity, time , aad value), developed a computer-assisted self-interview survey, sue d demonstrated its face and content validity, internal consistency, an d interrater reliability. Subjects were assigned survey computers for 5 consecutive weekdays over a 24-week period, into which they entered data when prompted several times a day. SETTING: The medical service o f a university-affiliated Veterans Administration Medical center. PART ICIPANTS: Sixty housestaff (36 interns, 24 residents) rotating on the inpatient wards. MEASUREMENTS AND MAIN RESULTS: We analyzed activities according to content (direct patient care, indirect patient care, edu cation), association, and location. Likert-scale ratings of perceived value to education and patient care were also obtained. Housestaff pro vided complete responses to 3,812 (95%) of 3,992 prompts by a median o f 11 seconds: 93% of responses were logically consistent across the me asured dimensions. Housestaff spent more time in indirect patient care (56%) than in direct patient care (14%) or educational activities (45 %). Formal educational activities had the highest educational value (6 6 on 0-100 scale), and direct care had the highest value to patient ca re (81). Over 30% of time was spent in administrative activities, whic h had low educational value (40). Compared with residents, interns all ocated significantly less time to educational activities (38% vs 57%) and more time to lower-value activities such as documentation (19% vs 12%). CONCLUSIONS: Improved data collection methods demonstrate that h ousestaff in our program, particularly interns, spend much of their wo rkday in activities that are Pow in educational and patient care value . Selective elimination or delegation of such activities would preserv e higher-value experiences during reductions in overall impatient trai ning time, planners can use automated random sampling to guide the rat ional redesign of housestaff work.