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Residents Spend More Time on Computer Than With Patients

 Internal medicine residents at a Swiss teaching hospital spent nearly three times as much time on the computer than they did with patients, a new study showed. Probably true with most physicians today with XXX computer recording!

“Overall, for every hour the residents spent with patients, they spent an average of 5 hours on other tasks,” the authors write. “For day shifts, writing in the EMR and writing the discharge summary were the most time-consuming activities, amounting to approximately 2 hours per shift.”

Although the percentage of direct patient care time was similar between day and evening shifts, the distribution of that time differed. “During day shifts, most of the time residents spent with patients corresponded to daily patient rounds in the morning and admissions in the afternoon. For evening shifts, time spent with patients was more evenly distributed among late patient admissions, unstable patient care, and emergency situations,” the authors explain.

The residents tended to use their after-hours time on computer tasks, such as entering notes. “Possible reasons include a better summing up of the clinical issues encountered, not being interrupted, and not needing to interact with other members of the medical team,” the authors suggest.

Unlike in the ambulatory care setting, residents rarely used the computer and interacted with patients simultaneously, which is likely a function of the hospital setting, as it “does not facilitate use of a computer during interaction with the patient.”

The disproportionate amount of time residents spend on computer tasks is concerning compared with direct patient care is concerning, according to the authors. “[T]he large amount of time dedicated to computer use or other activities not centered on the patient could lead to dissatisfaction of residents due to the limited medical value of such activities and could also increase the risk for burnout,” they write.

This concern is supported in the literature linking physician burnout to their dissatisfaction with the clerical burden of electronic health records and associated technology, as reported previously by Medscape Medical News. It also points to the need for academic health systems to “rethink residents’ work organization to fit the digital age,” the authors stress.

The authors suggest several interventions for improving the allocation of residents’ time, including increasing the number of residents per patient, although doing so may be cost-prohibitive; delegating administrative tasks, which account for 40 minutes per day of residents’ time in the current study; optimizing documentation support via speech or writing recognition systems or scribes; and improving/redefining documentation procedures and the “ergonomics” of EHRs, which “still fail to capture and synthesize the growing amount and complexity of clinical data.”

EHRs and other technology “are meant to increase the efficiency of health care practice, not detract from it,” Dr Wegner said. “Our findings indicate organizational and technology changes are needed to make sure that doesn’t happen.”

The authors have disclosed no conflicts of interest.
Ann Intern Med. Published online January 30, 2017.

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