SHM Converge Scientific Abstract ePoster Gallery-Hospitalist Workflows: A Systematic Review of Time and Motion Studies in Hospital Medicine

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This systematic review updated prior evidence on hospitalist time and motion studies (TMS) and introduced a novel quality assessment tool for evaluating how well these studies measure hospitalist workflow. The authors searched major databases for studies published from 1996 through October 2024 and included U.S. adult inpatient hospitalist studies that reported direct and indirect care time.<br /><br />From 225 studies screened, 19 underwent full-text review and 7 met inclusion criteria. Across these studies, the proportion of time hospitalists spent in direct patient care ranged from 13% to 25%, with overlapping confidence intervals, suggesting no clear difference across studies. However, study quality was highly variable, with ratings ranging from 1 to 5 out of 8 stars on the new assessment tool.<br /><br />The quality tool evaluated two broad domains: cohort representation and comparability. It considered whether studies reflected typical U.S. hospitalist settings, included a full range of work shifts, used reliable measurement methods, and clearly defined work categories. It also assessed whether studies accounted for multitasking, patient load, and patient complexity. Notably, studies that scored better for representing the cohort often scored worse on comparability, indicating a design trade-off.<br /><br />The review concludes that traditional TMS approaches, which focus mainly on direct versus indirect patient care time, may not fully capture how hospitalists actually work. Because methods and quality vary substantially across studies, the authors recommend standardizing hospitalist TMS design to improve comparisons over time and to better understand how workflow changes in response to external pressures.

Asset Subtitle

Michelle Knees

Meta Tag

Author List Mark J. Kissler, Michelle Knees, Samuel Porter

Category Research

Concept Time and Motion Study

Concept Direct Care Time

Concept Hospital Workflow

Concept Methodological Limitation

Concept Heterogeneity

Distinguished Non-Finalist

Presenter Organization University of Colorado Anschutz School of Medicine

Presenting Author Michelle Knees

Track Other

Keywords

hospitalist

time and motion studies

systematic review

workflow measurement

direct patient care

indirect care time

quality assessment tool

cohort representation

comparability

hospital workflow

Time and Motion Study

Direct Care Time

Hospital Workflow

Methodological Limitation

Heterogeneity