Abstract Details

Title Shifting the Balance from Indirect to Direct Patient Care in a Non-Surgical Residency Training Program: a Comprehensive Needs Assessment Study in Neurology Residents

Topic Practice, Policy, and Ethics

Presentation(s) P10 - Poster Session 10 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-001

Objective To identify inefficiencies and opportunities for improvement in resident workflow on an inpatient neurology service at a major teaching hospital.

Background The Accreditation Council for Graduate Medical �鶹��ýӳ�� “Back to Bedside” initiative hypothesizes that resident burnout may be reduced by enhancing meaning in daily work. This may be achieved by shifting the balance from time spent on non-clinical duties towards direct patient care [Hipp]. Recent studies demonstrate that residents spend more time on non-clinical tasks (oftentimes >50%) than direct patient care [Mamykina, Victores], with disproportionate amounts of time on electronic health record (EHR) documentation [Schattner]. This imbalance is important to address in neurology residency, in which burnout rates are high [Levin].

Design/Methods A survey was sent to all neurology residents on their perceptions of time usage and satisfaction with workflow. A time-motion study was performed with one observer shadowing residents during non-rounds time one-on-one. Semi-structured interviews were held with members of the same team (junior and senior residents followed by attending physician) to identify areas of systemic inefficiencies.

Results Thirteen of 19 residents responded to the survey, with 92% reporting highest time usage spent on documentation followed by looking up patient data. 12 of 13 respondents estimated spending >4 hours on the EHR per day, with 5 estimating >6 hours. Semi-structured interviews revealed themes of inefficiencies including unintuitive patient discharge workflow and mandatory documentation of clinically irrelevant information on EHR. Time-motion data revealed limited direct patient care time after rounds; one junior resident spent 24% of time on face-to-face patient care, 27% EHR use, and 44% indirect patient care.

Conclusions This study confirms findings based in other specialties that neurology residents spend a disproportionate amount of time on indirect patient care and documentation. Our evaluative tools identified possible workflow improvements such as simplifying the EHR discharge process.

Authors/Disclosures
K. H. Vincent Lau, MD (Boston Medical Center) PRESENTER	Dr. Lau has received personal compensation for serving as an employee of Alnylam Pharmaceuticals. Dr. Lau has or had stock in Alnylam Pharmaceuticals.
Lucia Ryll	No disclosure on file