Patient Care

QBs vs. Hospitalists


 

O K, I’ll admit it: I like football. Call me a Neanderthal, but there is nothing quite like an afternoon with friends watching a tightly contested game of titans battling it out on the gridiron. Back in January, I enjoyed that glorious weekend in which the NFC and AFC crown their respective champions, each sending a team of combatants to the Super Bowl.

Fully enjoying the Sunday afternoon of ambrosia requires tons of preparation. Practically speaking, this means clearing my schedule of such clutter as child-rearing and housekeeping, along with dispatching my wife to the store minutes before my friends arrive to procure a second-chin’s worth of kettle chips and a potomaniac’s quantity of cheap beer. Then I settle into the butt-dented comfort of my overworked couch, where I’m surrounded by a rowdy pack of friends.

The average hospitalist in this study spent only 18% of their time in direct-patient-care activities, including taking a patient history, examining a patient, and meeting with a patient’s family. Eighteen percent! Isn’t seeing patients why I became a doctor?

During hour three of the pre-game analysis, I can’t help but notice that my lovely wife, neither a fan of football or my friends spilling beer on her couch, has contracted a nasty case of the angry stink-eye, which she wields like a laser beam through my skull. I ponder the cost that all of this revelry, last-minute dispatching, and spilled beer will have on my marriage. Concluding that I indeed have at least three paws in the doghouse, I reflect on the facts that a) my wife is a saint; b) she reads this column—honey, read point “a” again; and c) Valentine’s Day is right around the corner.

Oh, well. The game must go on, and right now, it’s all about the NFL—hard-hitting, back-and-forth, in-your-face, smash-mouth action. Unbeatable. Unbeatable, that is, until you realize that a typical football game contains a lot of things, except for much actual football.

The Facts on Football

A recent Wall Street Journal analysis of NFL playoff games reported that the typical football game consists of many things, but not much real action. In fact, the average three-plus-hour telecast consists of just 10 minutes and 43 seconds of play. After subtracting about an hour of commercials, the rest of an average telecast consists of such things as players standing around (67 minutes), replays (17 minutes), and, of course, the all-important shots of cheerleaders—which is allotted, remarkably, only three seconds per game. Seems like more.

In percentage terms, the pie is doled out this way: standing around (58.5%), replays (14.5%), playing time (9.4%), coach shots (4.9%), sideline player shots (3.4%), referee shots (2.4%), crowd shots (0.9%), and other miscellany, such as footage of owners in their high-priced luxury suites (0.3%), the kicker warming up (0.2%), and, of course, cheerleaders (0.1%).

While this level of inaction has an enabling effect on convivial taunting, bet-brokering, and beer runs, it is, to be frank, a laughably low amount of action. How can an entire industry be built on such a level of inactivity? It’s a great question—one that induces a momentary chuckle until I consider how I spend much of my clinical days.

Inactivity in the Workplace

A 2006 paper in the Journal of Hospital Medicine tackled the issue of hospitalist workflow.1 Researchers followed 10 academic hospitalists through various parts of a routine day, all the while measuring to the minute how they spent their time. What they found would be as astounding to hospital outsiders as the NFL data, should anyone ever find themselves so deep in the boredom pit to be watching a hospitalist make rounds.

Which made me wonder: What would Brett Favre, the Minnesota Vikings’ future Hall of Fame quarterback, think if he were watching me ply my trade? Which led me to further wonder how far afield Brett Favre’s life would have to be derailed for him to watch me round. Finally, it left me wondering why I don’t spend my time wondering about more productive things.

Anyway, if Brett were to watch one of us, this is what he’d see: The average hospitalist in this study spent only 18% of their time in direct-patient-care activities, including taking a patient history, examining a patient, and meeting with a patient’s family. Eighteen percent! Isn’t seeing patients why I became a doctor?

While it’s more time than Brett Favre spends slinging the pigskin, it’s still an astonishingly low amount of time actually working with patients. Then there’s the “indirect patient care” category (e.g., reviewing tests, writing notes, making orders), where we spend 69% of our day. This is our time in the huddle, so to speak: lots of planning, little action. Further, these academic hospitalists spent 4% of their time on personal activities (e.g., lunch, bathroom breaks), and 3% of their time in each of the following endeavors: professional development (learning, conferences), teaching, and traveling from floor to floor seeing patients.

Another revealing find was that the average hospitalist spent 6% of their time paging other physicians and 7% returning pages from others (the average hospitalist received 3.4 pages an hour). That’s 13% of the day spent on the phone, or waiting for a phone to ring. That’s about 1.5 hours of a typical 12-hour shift. Over the course of a year, that equates to about 300 hours of time (25 shifts) spent in the paging process. If we could find a way to totally remove the paging process from hospital communication, the average hospitalist could accomplish the same amount of work they do now, and take an additional 20-25 days off per year. Perhaps we should wear high-tech helmets—you know, the kind quarterbacks like Brett Favre use to communicate with his coaches on the sidelines.

Efficient Solutions

Before my hospitalists hit me up for wireless communication devices and an extra three weeks of vacation, understand that much of the paging downtime likely is used for multitasking. In fact, in the study, 21% of a hospitalist’s time was spent working on more than one endeavor. Still, my experience tells me that there is a lot of time lost in the paging vortex.

Furthermore, the 3% of time hospitalists spent walking to other floors, 5% spent on discharge paperwork, and 1% of time spent on routine clerical work (did the researchers inadvertently report 1% instead of 10%?) adds up to nearly a tenth of the day that is either wasted, could be automated, or could be completed by ancillary staff.

To be clear, this happens through no fault of individual hospitalists. Rather, it results from the inefficiency of hospital care systems. And if we endeavor to enhance the revenue, efficiency, and satisfaction of our providers, we need to re-engineer our systems to alter that vast expanse of time spent on inactivity and inefficiency. This means adopting new modes of communication, moving toward geographic rounds, and generally retooling our operational inefficiencies.

Short of that, we risk becoming as idle as the NFL—without the cheerleaders. TH

Dr. Glasheen is The Hospitalist’s physician editor.

Reference

  1. O’Leary KJ, Liebovitz DM, Baker DW. How hospitalists spend their time: insights on efficiency and safety. J Hosp Med. 2006;1(2):88-93.

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