Are things different in the light of day? A time study of internal medicine house staff days.

PURPOSE: To determine how internal medicine house staff spend their days and compare activities during the day with those previously observed during night call.
SETTING: University-affiliated Veterans Affairs Medical Center.
DESIGN: Two internal medicine house staff teams (one PGY-1 [postgraduate year] and one PGY-2 or PGY-3) observed during 5 short call admitting days. MEASUREMENTS: Time in each activity recorded by trained observers, computed, summed, and compared with that of similar activities of house staff on night call.
RESULTS: House staff admitted an average of two patients each day. They spent, on average, 25 minutes per patient performing new patient histories and physical examinations, 29 minutes charting new patient information, and were interrupted after an average of 12 minutes during the new patient evaluation compared with 20, 19, and 7 minutes at night (p > 0.05). The average house officer spent 44 minutes in nonphysician duties and 11 minutes answering pages during the day. On average, house staff spent 3 minutes each day talking in person with patients' families.
CONCLUSIONS: A significant amount of time each day was spent performing nonphysician duties. Little time was spent evaluating each patient or in person with patients' families and similar amounts of time were spent in charting and in patient evaluation. House staff appeared to spend more time with new patients during the day than they did at night, although this finding was not statistically significant. As noted during night call, evaluations were frequently interrupted. Future studies should examine why house staff choose to distribute their time in the manner described in this and similar studies.