A preliminary study to gain insight into activity patterns, time allocation and simultaneous activities of hospital physicians was carried out.Therefore an observation instrument for time-motion-studies in hospital settings was developed and tested.35 participant observations of internists and surgeons of a German municipal 300-bed hospital were conducted.
Other Emory co-authors include: Jason Hockenberry, Ph D, assistant professor of health policy and management at Emory’s Rollins School of Public Health; Matthew Wheatley, MD, assistant professor of emergency medicine and Stephen Pitts, MD, MPH, associate professor of emergency medicine.
Hospital physicians' time is a critical resource in medical care. First, the time spent in direct patient contact – a key principle of effective medical care.
Inter-rater agreement of Kappa = .71 points to good reliability of the instrument.
Hospital physicians spent 25.5% of their time at work in direct contact with patients.
Ross, MD, professor of emergency medicine at Emory University School of Medicine and medical director of Observation Medicine at Emory Healthcare, and his co-authors, compared patients cared for in "type 1"observation units, which are defined as dedicated observation units with defined treatment protocols.
They used 2010 data from local, state and national clinical settings to examine findings.The local type 1 observation units observed in this study were at Emory University Hospital, Emory University Hospital Midtown and Grady Memorial Hospital, which are all staffed by Emory emergency department physicians."While avoidable emergency department visits are a common focus of national health policy debates, we chose to look beyond that to a much larger emergency department policy issue - that is avoidable hospital admissions," says Ross.Emory University researchers have found that the use of observation units in hospital emergency rooms could not only shorten patient stays and decrease inpatient admissions, but could save the health care system approximately .5 billion to .5 billion annually.The findings are being published in the December issue of the journal Health Affairs.This review looked at the benefits of type 1 units, which are usually found in large hospitals located in urban areas and are often teaching hospitals, like those within the Emory system.The authors point out that to encourage hospitals without observation units to adopt them, payers would need to create payment incentives for care provided in type 1 observation unit similar to what they have done with other types of emergency visits.The remaining one-third of hospitals have a designated observation unit, which is typically adjacent to the ED.Half of these hospitals (one-sixth of all hospitals) use condition specific protocols (type 1 setting); the other half do not (type 2 setting).Emory University Hospital Midtown had eight beds during the time of this study, but has since added 10 beds to make an 18-bed unit.At Grady Memorial Hospital, 8 beds were in use at the time of this study, but 12 beds have been added, creating a 20-bed observation unit.