Hospitalist time-motion studies: A systematic review.

Abstract

Hospitalist workflows have evolved significantly, yet optimal workflows and workloads remain ill-defined. Time and motion studies (TMSs) offer insights into hospitalist activities but face methodological challenges, including variability and lack of standardization. We aimed to systematically review TMSs of hospitalist workflows, assess trends in direct and indirect patient care, and develop a novel quality assessment tool for evaluating TMS studies. We conducted a comprehensive search of Ovid MEDLINE (1946-October 2024), Embase (1947-October 2024), and Web of Science (1974-October 2024) in August 2023 and updated October 7, 2024. We included studies that employed observational or quantitative TMS methods focused on attending hospitalists in US general adult inpatient settings and reported the proportion of time spent in direct and indirect patient care. We assessed study quality using a quality assessment tool adapted from the Newcastle-Ottawa scale. Seven studies met the inclusion criteria. Direct patient care accounted for a mean of 18% (range: 13%-25%) of observed time. We identified high variability in study quality, with scores ranging from 2 to 5 out of eight stars. Significant study variability precluded statistical analysis of trends, though a narrative synthesis was possible. Few studies represented diverse settings or shifts. This review utilizes a novel quality assessment tool and highlights the need for standardized TMS methodologies to enable longitudinal comparisons and more accurate assessments of hospitalist workflows. Future studies should integrate validated tools, consider multitasking, and explore emerging metrics beyond productivity.