Inpatient Hospital Factors and Resident Time With Patients and Families

Pediatrics. 2017 May;139(5):e20163011. doi: 10.1542/peds.2016-3011.


Objectives: To define hospital factors associated with proportion of time spent by pediatric residents in direct patient care.

Methods: We assessed 6222 hours of time-motion observations from a representative sample of 483 pediatric-resident physicians delivering inpatient care across 9 pediatric institutions. The primary outcome was percentage of direct patient care time (DPCT) during a single observation session (710 sessions). We used one-way analysis of variance to assess a significant difference in the mean percentage of DPCT between hospitals. We used the intraclass correlation coefficient analysis to determine within- versus between-hospital variations. We compared hospital characteristics of observation sessions with ≥12% DPCT to characteristics of sessions with <12% DPCT (12% is the DPCT in recent resident trainee time-motion studies). We conducted mixed-effects regression analysis to allow for clustering of sessions within hospitals and accounted for correlation of responses across hospital.

Results: Mean proportion of physician DPCT was 13.2% (SD = 8.6; range, 0.2%-49.5%). DPCT was significantly different between hospitals (P < .001). The intraclass correlation coefficient was 0.25, indicating more within-hospital than between-hospital variation. Observation sessions with ≥12% DPCT were more likely to occur at hospitals with Magnet designation (odds ratio [OR] = 3.45, P = .006), lower medical complexity (OR = 2.57, P = .04), and higher patient-to-trainee ratios (OR = 2.48, P = .05).

Conclusions: On average, trainees spend <8 minutes per hour in DPCT. Variation exists in DPCT between hospitals. A less complex case mix, increased patient volume, and Magnet designation were independently associated with increased DPCT.

MeSH terms

  • Diagnosis-Related Groups
  • Electronic Health Records
  • Humans
  • Inpatients*
  • Internship and Residency*
  • Length of Stay
  • Patient Care Team
  • Patient Care*
  • Physician-Patient Relations*
  • Professional-Family Relations*
  • Time and Motion Studies
  • Workload