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Sask., CANADA: 9,000 RNs in Sask.+ 719 fulltime physicians = 12% of time spent with patient

Let’s do some simple math. The Saskatoon Health Region has the equivalent of 719 fulltime physicians and has stated in the media that it requires another 202 fulltime doctors. One way to do this obviously is to hire a couple of hundred medical practitioners. Another way to accomplish the same goal is to increase the time spent on direct patient care by the current complement of doctors to 48 per cent from about 20 per cent. This would still leave ample room for documentation, self-education, research and teaching.

By Mark Lemstra, The Starphoenix November 21, 2013

CONCIERGEMEDICINEinCANADA2NOVEMBER 25, 2013 – Saskatoon, SK, CANADA – We always hear about the need to hire more healthcare practitioners for more patients to be seen, but no one ever talks about increasing patient exposure time among existing doctors, nurses and allied health workers.

A recent time-motion study published in the Journal of General Internal Medicine involved two leading medical centres and internal medicine specialists who agreed to be followed to see how they spent their time in hospitals.

Overall, only 12 per cent of their time was spent in direct patient care, while 64 per cent was used for documentation that included talking to other providers, reviewing charts and writing notes. As well, 15 per cent of their time was allocated for educational activities, and nine per cent for eating, socializing and miscellaneous other activities. The average time spent with a patient was eight minutes.

At this point, no one should underestimate the value of documentation. However, when the time spent on charting exceeds direct patient contact by a five-to-one ratio, something is wrong. In fact, this study is so important that it was commented upon by the New England Journal of Medicine.

In the review, Dr. Abigail Zuger commented that, “The distressing paucity of time that doctors spend with their patients is not a new phenomenon.” Although electronic medical records have been heralded as saviours to healthcare systems and touted to improve outcomes, Zuger suggests that valuable physician time is now being prioritized toward computers instead of patients. As with everything, a proper balance is required. Zuger concludes that this delicate balance now has tilted toward documentation and, as such, “things are clearly moving in the wrong direction.”

A similar study involving three teaching hospitals was published in General Medicine. It showed that 15 per cent to 26 per cent of physician time in hospitals was devoted toward patient evaluation, while 20 per cent to 38 per cent was devoted to communication or charting, and as much as 12 per cent was devoted to procedures that could have been handled by non-physicians. Most importantly, 24 per cent to 49 per cent of physician time in hospitals had absolutely nothing to do with patient care.

The results are worse at night. A study published in Academic Medicine showed that internal medicine residents in hospitals spent 16 per cent of their on-call time with patients, 27.7 per cent was spent performing chart reviews and documentation, and 56.3 per cent of their time was allocated to things that had nothing to do with patients.

Let’s not focus exclusively on doctors. The results of monitoring nurses at 36 separate units were published in the Permanante Journal and the American Journal of Nursing. Only 26 per cent of nursing time was allocated towards direct patient care, while 74 per cent was spent on something else. Again, charting took up the bulk of that time, with 35 per cent of nursing activity directed toward documentation.

An interesting part of these analyses is that all the doctors, residents and nurses agreed to be monitored and evaluated. In research, there is something called the Hawthorne effect, where the subjects who know they are being studied respond by changing the behaviour that’s being reviewed. It would be telling to know how much practitioner time is being spent on direct patient care in hospitals by those who do not consent to being evaluated.

Regardless, direct patient care obviously can be improved. In an initiative led by nurses, called Transforming Care at the Bedside, the average amount of nursing time spent on direct care increased to 50 per cent, with some units observing 90 per cent nursing time on direct patient care. These results were published in the American Journal of Nursing.

Let’s do some simple math. The Saskatoon Health Region has the equivalent of 719 fulltime physicians and has stated in the media that it requires another 202 fulltime doctors. One way to do this obviously is to hire a couple of hundred medical practitioners. Another way to accomplish the same goal is to increase the time spent on direct patient care by the current complement of doctors to 48 per cent from about 20 per cent. This would still leave ample room for documentation, self-education, research and teaching.

This is obviously a difficult topic to tackle, but it is also a necessary one.

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