The relationship between time spent communicating and communication outcomes on a hospital medicine service

Abstract

Background: Quality care depends on effective communication between caregivers, but it is unknown whether time spent communicating is associated with communication outcomes.

Objective: To assess the association between time spent communicating, agreement on plan of care, and patient satisfaction.

Design: Time-motion study with cross-sectional survey.

Setting: Academic medical center.

Participants: Physicians, patients, and nurses on a hospital medicine service.

Measurements: Hospitalists' forms of communication were timed with a stopwatch. Physician-nurse agreement on the plan of care and patient satisfaction with physician communication were assessed via survey.

Results: Eighteen hospitalists were observed caring for 379 patients. On average, physicians spent more time per patient on written than verbal communication (median: 9.2 min. vs. 6.3 min, p<0.001). Verbal communication was greatest with patients (mean time 5.3 min, range 0-37 min), then other physicians (1.4 min), families (1.1 min), nurses (1.1 min), and case managers (0.4 min). There was no verbal communication with nurses in 30% of cases. Nurses and physicians agreed most about planned procedures (87%), principal diagnosis (74%), tests ordered (73%), anticipated discharge date (69%) and least regarding medication changes (59%). There was no association between time spent communicating and agreement on plan of care. Among 123 patients who completed surveys (response rate 32%), time physicians spent talking to patients was not correlated with patients' satisfaction with physician communication (Pearson correlation coefficient = 0.09, p=0.30).

Conclusions: Hospitalists vary in the amount of time they spend communicating, but we found no association between time spent and either patient satisfaction or nurse-physician agreement on plan of care.

Figure 1

Hospitalist time spent per patient on different types of verbal and written communication.

Figure 2

Individual physicians’ communication times per patient (median and interquartile ranges).