How Digital and Physical Care Team Interaction Affect Processing Times: A Case Study of Hospitalists

Journal of Case Report and Studies, 5(6): 606, 2017

18 Pages Posted: 13 Nov 2017 Last revised: 28 Dec 2017

Date Written: November 8, 2017

Abstract

Importance: Hospitalist physicians face increasing pressure to maximize productivity while maintaining high quality of care. Their success, however, depends on the effective exchange of information among a patient’s care team. The latter comprises the digital team (caregivers who document in — not just access — the patient’s electronic health record) and a physical team (caregivers who directly communicate with the hospitalist).

Objective: To determine the association between hospitalist total daily processing time per patient and the size and evolution over the patient’s LOS of the digital and physical teams as well as patient-level characteristics.

Design: We measured hospitalist daily processing times and captured the physical team through a time-and-motion study of hospitalists. The digital team interactions were extracted from patient Electronic Health Records.

Setting: Northwestern Memorial Hospital, a large academic urban hospital in Chicago. Participants Our case study selected four hospitalists at random who cared for 107 inpatient stays over 17 days in June-July 2014 and collaborated with 2046 caregivers: 301 were observed physical collaborators and 1745 were digital-only collaborators.

Exposures: Hospitalist activities and patient encounters from observations and electronic health records.

Main Outcomes and Measures: Processing time is the total time spent by the hospitalist on a patient’s care per day. Key covariates are patient-level characteristics, interruptions by physical team members, and size and evolution of both the digital and physical teams.

Results: Teamwork interaction and patient-level characteristics explain 72% (18.9min) and 28% (7.2min), respectively, of the hospitalist’s average patient processing time of 26.7min per day. Teamwork is further decomposed in two ways: (i) 18.9 = 15.4 3.5 where 15.4min and 3.5min captures the teamwork effect at a macro level (driven by team size and stability variables) and micro level effect (hospitalist workflow interruptions driven by task switches), respectively; (ii) 18.9 = 8.8 10.1 where 8.8min and 10.1min capture digital and physical team variables, respectively. As a benchmark, eliminating interruptions reduces processing times by 3.5min (13%) while minimizing team size and maximizing team stability reduces processing times by 7.8min (29%).

The supplementary materials can be found here: http://ssrn.com/abstract=3068197.

Suggested Citation

Gurvich, Itai and Wang, Lu and O'Leary, Kevin and Soulakis, Nicholas and Van Mieghem, Jan Albert, How Digital and Physical Care Team Interaction Affect Processing Times: A Case Study of Hospitalists (November 8, 2017). Journal of Case Report and Studies, 5(6): 606, 2017, Available at SSRN: https://ssrn.com/abstract=3068175 or http://dx.doi.org/10.2139/ssrn.3068175

Itai Gurvich

Northwestern University ( email )

2001 Sheridan Road
Evanston, IL 60208
United States

Lu Wang

Northwestern University - Kellogg School of Management ( email )

2001 Sheridan Road
Evanston, IL 60208
United States

Kevin O'Leary

Northwestern University - Feinberg School of Medicine ( email )

Chicago, IL 60611
United States

Nicholas Soulakis

Northwestern University - Feinberg School of Medicine ( email )

Chicago, IL 60611
United States

Jan Albert Van Mieghem (Contact Author)

Northwestern University - Kellogg School of Management ( email )

2001 Sheridan Road
Evanston, IL 60208
United States

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