Clinical Question: How do hospitalists allocate their time during clinical work, and are quality assessment tools effective in measuring hospitalist workflow?
Background: Despite the rapid growth of hospital medicine, optimal hospitalist workflows and workloads remain poorly defined. Time-motion studies (TMSs) use observation to track systematically how workers allocate their time across activities. This research strategy can provide insights into how hospitalists spend their time, but methodological variability has limited the ability to compare findings across studies.
Study Design: Systematic review
Setting: U.S. academic and community hospitals
Synopsis: This systematic review searched MEDLINE, Embase, and Web of Science from 1996 to October 2024 and identified seven TMSs of attending hospitalists. The authors developed a novel, star-based, assessment tool adapted from the Newcastle-Ottawa Scale for cohort studies to evaluate study quality and to ensure studies accurately and consistently represent real-world hospitalist work. Direct patient care accounted for a mean 18% (range 13% to 25%) of observed hospitalist time. Study quality was highly variable, with scores ranging from 2 to 5 out of 8 stars. Significant heterogeneity in study methodologies limited statistical meta-analysis, though narrative synthesis was possible.
Bottom Line: Hospitalists spend approximately one-fifth of their time in direct patient care, but methodological heterogeneity across TMSs limits the ability to extrapolate trends and compare workflows. More standardized ways to measure this are needed in the future.
Citation: Porter S, et al. Hospitalist time-motion studies: a systematic review. J Hosp Med. 2025;20(10):1099-1107. doi:10.1002/jhm.70092.
Dr. Reyes
Dr. Reyes is a hospitalist in the division of hospital medicine at UC San Diego Health and an assistant clinical professor of medicine at UC San Diego, both