Juggling Between Paperwork and Patient Care: How Residents View Their Time Division in Clinical Training?
DOI:
https://doi.org/10.36570/jduhs.2020.2.974Keywords:
Clinical documentation, Patient care, Stress, Residents, Hospital record systems, Teaching and learningAbstract
Objective: The objective of this study was to explore residents’ perception of time they spend on clinical data and patient care.
Methods: A cross-sectional study, utilizing a validated questionnaire was conducted in July 2019 at the King Fahad Armed Forces Hospital, Jeddah after gaining ethical approval. Link to the online survey designed on Google forms was shared through Facebook, WhatsApp, and Email. The questionnaire consisted of 21 items to assess different variables like direct patient care, documentation requirements, and complete patient interaction.
Results: Out of 150 participants, the response rate was 111 (74%). Of 111 participants, regarding clinical documentation, 105 (95%) felt that it has become excessive, and 93 (84%) agreed that it compromises patient time. In addition, 87 (78%) residents felt rushed all the time and 82 (74%) said that they are frustrated with data entry. On the educational value of clinical documentation, 90 (81%) of residents agreed that it has little or no influence. Furthermore, 92 (83%) agreed that it negatively impacts the time available for teaching other junior residents.
Conclusion: We conclude that: although residents wish to provide quality care to their patients, many of them felt that data entry has become excessive and it is negatively affecting their clinical training.
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References
2. Ammenwerth E, Spötl HP. The time needed for clinical documentation versus direct patient care. A work-sampling analysis of physicians' activities. Methods Inf Med 2009; 48: 84–91.
3. Tajirian T, Stergiopoulos V, Strudwick G, Sequeira L, Sanches M, Kemp J, et al. (2020). The Influence of Electronic Health Record Use on Physician Burnout: Cross-Sectional Survey. J Med Int Res 2020; 22, e19274. doi.org/10.2196/19274
4. Collier R. Electronic health records contributing to physician burnout. CMAJ 2017; 189: E1405–E1406. doi.org/10.1503/cmaj.109-5522
5. Hejazi, R. Characteristics and dropout rate among residents in a tertiary hospital in Jeddah, Saudi Arabia: a cross-sectional study. Int J Adv Res 2018; 6: 927–30. doi:10.21474/ijar01/7595
6. Drum JL, Medvene LJ. The social convoys of affordable senior housing residents: Fellow residents and “Time Left”. Edu Gerontol 2017; 43: 540-51. doi.org/10.1080/03601277.2017.1344081 .
7. Christino MA, Matson AP, Fischer SA, Reinert SE, Digiovanni CW, Fadale PD. Paperwork versus patient care: a nationwide survey of residents' perceptions of clinical documentation requirements and patient care. J Grad Med Edu 2013; 5: 600–4. doi.org/10.4300/JGME-D-12-00377
8. Amin RP, Johansen ME. Tethered to the EHR: a physician workload assessment. Ann Fam Med 2017; 15:iii. doi.org/10.1370/afm.2147
9. Cusack CM, Hripcsak G, Bloomrosen M, Rosenbloom ST, Weaver CA, Wright A, et al. The future state of clinical data capture and documentation: a report from AMIA's 2011 policy meeting. J Am Med Inform Assoc 2013; 20: 134–40. doi.org/10.1136/amiajnl-2012-001093
10. Hripcsak G, Vawdrey DK, Fred MR, Bostwick SB. Use of electronic clinical documentation: time spent and team interactions. J Am Med Inform Assoc 2011; 18: 112–7. doi.org/10.1136/jamia.2010.008441
11. Al-Hanawi MK, Alsharqi O, Almazrou S, Vaidya K. Healthcare finance in the Kingdom of Saudi Arabia: a qualitative study of householders' attitudes. Appl Health Econ Health Policy 2018; 16: 55–64. doi.org/10.1007/s40258-017-0353-7
12. Bin Abdulrahman KA, Tawfik B. Strategic directions for university hospitals in Saudi Arabia. Med Teach 2016; 38: S1–S4. doi.org/10.3109/0142159X.2016.1142518
13. Mamykina L, Vawdrey DK, Hripcsak G. How do residents spend their shift time? a time and motion study with a particular focus on the use of computers. Academic medicine: J Assoc Am Med Coll. 2016; 91: 827–32. doi.org/10.1097/ACM.0000000000001148
14. Han ER, Chung EK. The perception of medical residents and faculty members on resident duty hour regulation. Korean J Med Edu. 2020; 32: 67–72. doi.org/10.3946/kjme.2020.154
15. Arndt BG, Beasley JW, Watkinson MD, Temte JL, Tuan WJ, Sinsky CA, et al. Tethered to the ehr: primary care physician workload assessment using ehr event log data and time-motion observations. Ann Fam Med 2017; 15: 419–26. doi.org/10.1370/afm.2121
16. Lin CT, Albertson GA, Schilling LM, Cyran EM, Anderson SN, Ware L, et al. Is patients' perception of time spent with the physician a determinant of ambulatory patient satisfaction? Arch Intern Med 2001; 161: 1437–42. doi.org/10.1001/archinte.161.11.1437
17. Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Int Med 2016; 165: 753–60. doi.org/10.7326/M16-0961
18. Gottschalk A, Flocke SA. Time spent in face-to-face patient care and work outside the examination room. Ann Fam Med 2005; 3:488-93.
19. Marcinowicz L, Chlabicz S, Grebowski R. Patient satisfaction with healthcare provided by family doctors: primary dimensions and an attempt at typology. BMC Health Serv Res 2009; 9: 63. doi.org/10.1186/1472-6963-9-63
20. Kafetsios K, Anagnostopoulos F, Lempesis E, Valindra A. Doctors' emotion regulation and patient satisfaction: a social-functional perspective. Health Commu 2014; 29: 205–14. doi.org/10.1080/10410236.2012.738150
21. Kafetsios K, Hantzara K, Anagnostopoulos F, Niakas D. Doctors' attachment orientations, emotion regulation strategies, and patient satisfaction: a multilevel analysis. Health Commun 2016; 31, 772–7. doi.org/10.1080/10410236.2014.993497
22. Van Den AB, Dulewicz V. Doctors' trustworthiness, practice orientation, performance and patient satisfaction. Int J Health Care Qual Assur 2015; 28: 82–95. doi.org/10.1108/IJHCQA-04-2013-0037
23. Wenger N, Méan M, Castioni J, Marques-Vidal P, Waeber G, Garnier A. Allocation of internal medicine resident time in a swiss hospital: a time and motion study of day and evening shifts. ann int med 2017; 166: 579–86. doi.org/10.7326/m16-2238
24. Johns MM, Wolman DM, Ulmer C, editors. Resident duty hours: enhancing sleep, supervision, and safety. National Academies Press 2009.
25. Chandra S, Ward P, Mohammadnezhad M. Factors associated with patient satisfaction in outpatient department of suva sub-divisional health center, fiji, 2018: a mixed method study. Front Public Health 2019; 7:183. doi.org/10.3389/fpubh.2019.00183
26. Chen L, Guo U, Illipparambil LC, Netherton MD, Sheshadri B, Karu E, et al. Racing against the clock: internal medicine residents' time spent on electronic health records. J Grad Med Edu 2016; 8: 39–44. doi.org/10.4300/JGME-D-15-00240
27. Downing NL, Bates DW, Longhurst CA. Physician burnout in the electronic health record era: are we ignoring the real cause? Ann Int Med 2018; 169: 50–1. doi.org/10.7326/M18-0139
28. Lown BA, Rosen J, Marttila J. An agenda for improving compassionate care: a survey shows about half of patients say such care is missing. Health Affairs 2011; 30, 1772–8. doi.org/10.1377/hlthaff.2011.0539
29. Aalam, A, Zocchi M, Alyami K, Shalabi A, Bakhsh A, Alsufyani A, et al. Perceptions of emergency medicine residents on the quality of residency training in the United States and Saudi Arabia. World J Emerg Med 2018; 9: 5–12. doi.org/10.5847/wjem.j.1920-8642.2018.01.001
30. Jamoom EW, Patel V, Furukawa MF, King J. EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption. Health Care 2014; 2: 33–9. doi.org/10.1016/j.hjdsi.2013.12.004
31. Fountain D, Quach C, Norton D, White S, Ratliff S, Molteg K, et al. The perfect storm is on the horizon!. J Surg Edu 2017; 74:e120-3.
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Copyright (c) 2020 Faezah Siddiqui, Ali Awais Malik, Dr.
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