Hospitalist time-motion studies: A systematic review

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine Pub Date : 2025-06-11 DOI:10.1002/jhm.70092

Samuel Porter MD, Michelle Knees DO, Laura Meimari MD, Christi Piper MLIS, AHIP, Mark Kissler MD

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引用次数: 0

Abstract

Background

Hospitalist workflows have evolved significantly, yet optimal workflows and workloads remain ill-defined. Time and motion studies (TMSs) offer insights into hospitalist activities but face methodological challenges, including variability and lack of standardization.

Objectives

We aimed to systematically review TMSs of hospitalist workflows, assess trends in direct and indirect patient care, and develop a novel quality assessment tool for evaluating TMS studies.

Methods

We conducted a comprehensive search of Ovid MEDLINE (1946–October 2024), Embase (1947–October 2024), and Web of Science (1974–October 2024) in August 2023 and updated October 7, 2024. We included studies that employed observational or quantitative TMS methods focused on attending hospitalists in US general adult inpatient settings and reported the proportion of time spent in direct and indirect patient care. We assessed study quality using a quality assessment tool adapted from the Newcastle-Ottawa scale.

Results

Seven studies met the inclusion criteria. Direct patient care accounted for a mean of 18% (range: 13%–25%) of observed time. We identified high variability in study quality, with scores ranging from 2 to 5 out of eight stars. Significant study variability precluded statistical analysis of trends, though a narrative synthesis was possible. Few studies represented diverse settings or shifts.

Conclusions

This review utilizes a novel quality assessment tool and highlights the need for standardized TMS methodologies to enable longitudinal comparisons and more accurate assessments of hospitalist workflows. Future studies should integrate validated tools, consider multitasking, and explore emerging metrics beyond productivity.

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医院时间运动研究：系统回顾。

背景：医院工作流程已经发生了重大变化，但最佳工作流程和工作量仍然不明确。时间和运动研究（tms）提供了对医院医生活动的见解，但面临方法上的挑战，包括可变性和缺乏标准化。目的：我们旨在系统地回顾医院工作流程的TMS，评估直接和间接患者护理的趋势，并开发一种新的质量评估工具来评估TMS研究。方法：我们于2023年8月对Ovid MEDLINE （1946-October 2024）、Embase （1947-October 2024）和Web of Science （1974-October 2024）进行综合检索，并于2024年10月7日更新。我们纳入了采用观察性或定量TMS方法的研究，这些研究集中在美国普通成人住院医院，并报告了用于直接和间接患者护理的时间比例。我们使用从纽卡斯尔-渥太华量表改编的质量评估工具来评估研究质量。结果：7项研究符合纳入标准。患者直接护理平均占观察时间的18%（范围：13%-25%）。我们确定了研究质量的高度可变性，评分范围从2到5分（满分为8星）。显著的研究变异性妨碍了趋势的统计分析，尽管叙述综合是可能的。很少有研究代表不同的环境或变化。结论：本综述采用了一种新颖的质量评估工具，并强调需要标准化的经颅磁刺激方法来进行纵向比较和更准确地评估医院医生的工作流程。未来的研究应该整合有效的工具，考虑多任务处理，并探索生产力之外的新兴指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of hospital medicine 医学-医学：内科

CiteScore

4.40

自引率

11.50%

发文量

233

审稿时长

4-8 weeks

期刊介绍： JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.