Full work analysis of resident work hours

Abstract

Background: Resident duty hour restrictions, while intended to improve patient safety and resident well-being, may decrease time available for patient care and education. Our objective was to perform in-depth analysis of how a pediatric surgical resident utilizes his time in hopes of eliminating waste, and in effect, add educationally relevant hours.

Materials and methods: Work done by a senior pediatric surgical resident was prospectively collected using three methods. The duty hours logged by the resident for a full academic year were analyzed. A detailed work analysis was performed by an independent observer who videotaped the resident. Finally, the resident recorded and categorized his daily activities during the month in which the videotaping occurred.

Results: 18.9 h (1134.9 min) of videotaped data were collected. The total time spent directly related to patient care, including the operating room, was 656 min. One hundred seventy-five min were spent on education, both didactic and teaching on the wards. The resident spent 139.8 min traveling within the hospital; 132.7 min were categorized as communication; only 1.5% of time was deemed pure waste. A total of 344.75 h (20,685 min) were self-reported and categorized. Didactic education comprised 6.7% of total time while less formal teaching is embedded in the clinical activities of consultation, rounds, and clinic.

Conclusions: Increased efficiency in the operating room, where the most time was spent, coupled with workflow redesigns that decrease travel and time spent on the phone would increase time available for education and patient care.