Enhancing Patient-Dedicated Time in Clinical Encounters: A Systematic Review and Meta-analysis of Intervention Strategies.

Abstract

Background: Hospitals' institutional programs designed to protect or increase the time dedicated to interactions between patients and healthcare professionals, while growing in popularity, often lack formal evaluation. This study aims to quantify the effectiveness of programs designed to protect or enhance the quality or quantity of clinical encounter time between hospitalized patients and healthcare professionals.

Methods: A systematic literature review and random-effects meta-analysis were performed on Cochrane Library, Embase, and Web of Science databases. Studies had to include ≥ 80% adult inpatients in acute care, compare groups, and assess at least one of the following outcomes: patient satisfaction, length of stay, home discharge, or 30-day readmission. Screening, data extraction, and risk of bias assessment were performed independently and in duplicate. Risk of bias was assessed using the ROBINS-I tool for non-randomized trials, and the Cochrane 2.0 instrument for randomized trials.

Results: A total of 117 unique studies comprising 298,517 patients were included. Compared to their controls, interventions increased the proportion of satisfied patients (+ 8% [95% CI, + 4.7 to + 11.4%]; 26 studies, 20,456 patients), the proportion of patients discharged home (+ 2.6% [95% CI, + 0.3 to + 5.0%]; 21 studies, 61,539 patients), and reduced length of stay (- 1.07 days [95% CI, - 1.62 to - 0.52]; 58 studies, 160,080 patients) without significant difference in readmission rates (- 0.8% [95% CI - 1.8 to + 0.2%]; 49 studies, 177,677 patients). Most studies were at high risk of bias, even among randomized trials. Programs varied widely in interventions, contexts, and findings.

Discussion: Programs enhancing or protecting clinical encounter time in acute care may improve patient experience, care quality, and discharge processes. Higher quality randomized controlled trials evaluating such interventions are warranted. Future programs may benefit from studies that draw on multi-disciplinary knowledge and implementation sciences to identify contextual factors impacting their success.

Systematic review registration: Prospero CRD42023453402.