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How Digital and Physical Care Team Interaction Affect Processing Times: A Case Study of Hospitalists, Journal of Case Reports and Studies

Abstract

Importance: Hospitalist physicians face increasing pressure to maximize productivity while maintaining high quality of care. eir success, however, depends on the e ective exchange of information among a patient’s care team. e latter comprises the digital team (caregivers who document in—not just access—the patient’s electronic health record) and a physical team (caregivers who directly communicate with the hospitalist). Objective: To determine the association between hospitalist total daily processing time per patient and the size and evolution over the patient’s length of stay (LOS) of the digital and physical teams as well as patient-level characteristics. Design: We measured hospitalist daily processing times and captured the physical team through a time-and-motion study of hospitalists. e digital team interactions were extracted from patient Electronic Health Records. Setting: Northwestern Memorial Hospital, a large academic urban hospital in Chicago. Participants Our case study selected four hospitalists at random who cared for 107 inpatient stays over 17 days in June-July 2014 and collaborated with 2046 caregivers: 301 were observed physical collaborators and 1745 were digital-only collaborators. Exposures: Hospitalist activities and patient encounters from observations and electronic health records. Main Outcomes and Measures: Processing time is the total time spent by the hospitalist on a patient’s care per day. Key covariates are patient-level characteristics, interruptions by physical team members, and size and evolution of both the digital and physical teams. Results Teamwork interaction and patient-level characteristics explain 72% (18.9min) and 28% (7.2min), respectively, of the hospitalist’s average patient processing time of 26.7min per day. Teamwork is further decomposed in two ways: (i) 18.9 = 15.4 + 3.5 where 15.4min and 3.5min captures the teamwork e ect at a macro level (driven by team size and stability variables) and micro level e ect (hospitalist work ow interruptions driven by task switches), respectively; (ii) 18.9 = 8.8 + 10.1 where 8.8min and 10.1min capture digital and physical team variables, respectively. As a benchmark, eliminating interruptions reduces processing times by 3.5min (13%) while minimizing team size and maximizing team stability reduces processing times by 7.8min (29%). Conclusion and Relevance: Hospitalist processing times are impacted as much by the digital as the physical care team characteristics. Although our ndings should be validated in di erent clinical settings, they suggest the need to combine digital data with observational data to evaluate hospitalist processing times and to mitigate the negative e ects of interruptions and care team turnover.

Type

Article

Author(s)

Itai Gurvich, Lu Wang, Kevin J. O'Leary, Nicholas Dean Soulakis, Jan A. Van Mieghem

Date Published

2017

Citations

Gurvich, Itai, Lu Wang, Kevin J. O'Leary, Nicholas Dean Soulakis, and Jan A. Van Mieghem. 2017. How Digital and Physical Care Team Interaction Affect Processing Times: A Case Study of Hospitalists. Journal of Case Reports and Studies. 5(6): 1-10.

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