During one shift last week, I felt as if I was spending too much time doing computerized charting, computerized order entry, and computerized admit orders [contractually required to write them – don’t ask]and not enough time with patients and their families.
This week, I decided to account for every minute of my time during a 12 hour shift in a moderately busy emergency department where I was the only physician working. I had to scrap the first time I tried it because I kept forgetting to write things down. The next shift, I put the notes where I wouldn’t forget – right next to the computer keyboard with portable clock sitting on top of them.
There is a little bit of overlap between categories when I was multitasking. For example, if I was speaking to a doctor on the phone while charting, I counted the time as only speaking to the doctor. Out of a total of 720 minutes in the shift, I calculated that I spent the following amount of time performing the following tasks:
Seeing patients: 247 minutes
Time on computer: 365 minutes including …
–Charting/entering orders and labs to be done: 219 minutes
–Looking up old medical records: 42 minutes
–Entering discharge instructions/prescriptions: 41 minutes
–Entering admit orders/completing transfer forms: 63 minutes
Discussions with other physicians: 69 minutes
Researching medical issues: 13 minutes
Eating lunch: 5 minutes
Personal phone call: 4 minutes
Miscellaneous down time: 12 minutes
Sign out to oncoming physician: 5 minutes
Longest time between patient exams: 47 minutes
Involving: 24 combined minutes charting patient’s condition and entering orders, 13 minutes discussing the patient condition with three physicians, 10 minutes completing transfer documents and giving report to medics
I probably write more than most docs on my patient charts. Even so, more than half of my time was spent making sure that the charts were documented sufficiently to satisfy hospital administrators, to please governmental payors, and to smite plaintiff attorneys.
I’ve had some nurses tell me that I spend too much time with patients. My shift averaged 7-11 minutes per patient, with a few outliers. In total, I spent only one-third of my 12 hour shift with patients and their families. That’s too much?
Kind of disappointing to realize how the practice of medicine has “evolved.”