Journal of General Internal Medicine

, Volume 27, Issue 2, pp 185–189

The Relationship Between Time Spent Communicating and Communication Outcomes on a Hospital Medicine Service

  • Michael B. Rothberg
  • John R. Steele
  • John Wheeler
  • Ashish Arora
  • Aruna Priya
  • Peter K. Lindenauer
Original Research

ABSTRACT

BACKGROUND

Quality care depends on effective communication between caregivers, but it is unknown whether time spent communicating is associated with communication outcomes.

OBJECTIVE

To assess the association between time spent communicating, agreement on plan of care, and patient satisfaction.

DESIGN

Time-motion study with cross-sectional survey.

SETTING

Academic medical center.

PARTICIPANTS

Physicians, patients, and nurses on a hospital medicine service.

MEASUREMENTS

Hospitalists’ forms of communication were timed with a stopwatch. Physician–nurse agreement on the plan of care and patient satisfaction with physician communication were assessed via survey.

RESULTS

Eighteen hospitalists were observed caring for 379 patients. On average, physicians spent more time per patient on written than verbal communication (median: 9.2 min. vs. 6.3 min, p < 0.001). Verbal communication was greatest with patients (mean time 5.3 min, range 0–37 min), then other physicians (1.4 min), families (1.1 min), nurses (1.1 min), and case managers (0.4 min). There was no verbal communication with nurses in 30% of cases. Nurses and physicians agreed most about planned procedures (87%), principal diagnosis (74%), tests ordered (73%), anticipated discharge date (69%) and least regarding medication changes (59%). There was no association between time spent communicating and agreement on plan of care. Among 123 patients who completed surveys (response rate 32%), time physicians spent talking to patients was not correlated with patients’ satisfaction with physician communication (Pearson correlation coefficient = 0.09, p = 0.30).

CONCLUSIONS

Hospitalists vary in the amount of time they spend communicating, but we found no association between time spent and either patient satisfaction or nurse-physician agreement on plan of care.

KEY WORDS

communication hospital medicine outcomes 

Supplementary material

11606_2011_1857_MOESM1_ESM.doc (42 kb)
ESM 1(DOC 42 kb)

REFERENCES

  1. 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.PubMedCrossRefGoogle Scholar
  2. 2.
    Kim CS, Lovejoy W, Paulsen M, Chang R, Flanders SA. Hospitalist time usage and cyclicality: opportunities to improve efficiency. J Hosp Med. 2010;5(6):329–334.PubMedCrossRefGoogle Scholar
  3. 3.
    Tipping MD, Forth VE, O’Leary KJ, et al. Where did the day go?–a time-motion study of hospitalists. J Hosp Med. 2010;5(6):323–328.PubMedCrossRefGoogle Scholar
  4. 4.
    Westbrook JI, Ampt A, Kearney L, Rob MI. All in a day’s work: an observational study to quantify how and with whom doctors on hospital wards spend their time. Med J Aust. 2008;188(9):506–509.PubMedGoogle Scholar
  5. 5.
    Weigl M, Muller A, Zupanc A, Angerer P. Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians. BMC Health Serv Res. 2009;9:110.PubMedCrossRefGoogle Scholar
  6. 6.
    Becker G, Kempf DE, Xander CJ, Momm F, Olschewski M, Blum HE. Four minutes for a patient, twenty seconds for a relative - an observational study at a university hospital. BMC Health Serv Res. 2010;10:94.PubMedCrossRefGoogle Scholar
  7. 7.
    O’Leary KJ, Thompson JA, Landler MP, et al. Patterns of nurse-physician communication and agreement on the plan of care. Qual Saf Health Care. 2010;19(3):195–199.PubMedCrossRefGoogle Scholar
  8. 8.
    O’Leary KJ, Kulkarni N, Landler MP, et al. Hospitalized patients’ understanding of their plan of care. Mayo Clin Proc. 2010;85(1):47–52.PubMedCrossRefGoogle Scholar
  9. 9.
    Agency for Healthcare Research and Quality. HCAHPS Survey. Available at: http://www.hcahpsonline.org/Files/V5%200%20Appendix%20A%20-%20HCAHPS%20Mail%20Survey%20Materials%20(English).pdf. Accessed August 16, 2011.
  10. 10.
    O’Leary KJ, Wayne DB, Landler MP, et al. Impact of localizing physicians to hospital units on nurse-physician communication and agreement on the plan of care. J Gen Intern Med. 2009;24(11):1223–1227.PubMedCrossRefGoogle Scholar
  11. 11.
    Most say doctors should talk to each other. United Press International. Available at http://www.upi.com/Health_News/2010/04/12/Most-say-doctors-should-talk-to-each-other/UPI-49701271048173/. Accessed April 12, 2010.
  12. 12.
    Edwards A, Fitzpatrick LA, Augustine S, et al. Synchronous communication facilitates interruptive workflow for attending physicians and nurses in clinical settings. Int J Med Inform. 2009;78(9):629–637.PubMedCrossRefGoogle Scholar
  13. 13.
    Kim MM, Barnato AE, Angus DC, Fleisher LA, Kahn JM. The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med. 2010;170(4):369–376.PubMedCrossRefGoogle Scholar
  14. 14.
    Vazirani S, Hays RD, Shapiro MF, Cowan M. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care. 2005;14(1):71–77.PubMedGoogle Scholar
  15. 15.
    O’Leary KJ, Haviley C, Slade ME, Shah HM, Lee J, Williams MV. Improving teamwork: impact of structured interdisciplinary rounds on a hospitalist unit. J Hosp Med. Jul 13 2010.Google Scholar
  16. 16.
    O’Mahony S, Mazur E, Charney P, Wang Y, Fine J. Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. J Gen Intern Med. 2007;22(8):1073–1079.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Michael B. Rothberg
    • 1
    • 2
    • 3
    • 5
  • John R. Steele
    • 4
  • John Wheeler
    • 2
    • 3
  • Ashish Arora
    • 2
    • 3
  • Aruna Priya
    • 1
  • Peter K. Lindenauer
    • 1
    • 3
  1. 1.Center for Quality of Care ResearchSpringfieldUSA
  2. 2.Division of General MedicineBaystate Medical CenterSpringfieldUSA
  3. 3.Tufts University School of MedicineBostonUSA
  4. 4.Dartmouth CollegeHanoverUSA
  5. 5.Division of General Medicine and GeriatricsBaystate Medical CenterSpringfieldUSA

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