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Hospitalist time-motion studies: A systematic review
Samuel Porter1, Michelle Knees1, Laura Meimari2
1Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Journal of Hospital Medicine
|June 12, 2025
Summary
Optimal hospitalist workflows are unclear. Time and motion studies (TMSs) show direct patient care is only 18% of a hospitalist's time, but study quality varies greatly, hindering progress.
Area of Science:
- Healthcare Management
- Medical Informatics
- Clinical Operations
Background:
- Hospitalist workflows and workloads require optimization, with current practices ill-defined.
- Time and motion studies (TMSs) provide insights but suffer from methodological inconsistencies and lack of standardization.
- Understanding hospitalist time allocation is crucial for improving efficiency and patient care.
Purpose of the Study:
- To systematically review time and motion studies (TMSs) of hospitalist workflows.
- To analyze trends in direct versus indirect patient care time for hospitalists.
- To develop and apply a novel quality assessment tool for evaluating TMS studies.
Main Methods:
- Comprehensive literature search of Ovid MEDLINE, Embase, and Web of Science databases.
- Inclusion of observational or quantitative TMS studies on US general adult hospitalists reporting time allocation.
- Quality assessment using a tool adapted from the Newcastle-Ottawa scale.
Main Results:
- Seven studies met inclusion criteria, revealing direct patient care averaged 18% (range: 13%-25%) of observed time.
- Significant variability in study quality was observed (scores 2-5/8 stars), precluding statistical trend analysis.
- Limited representation of diverse settings and work shifts in the included studies.
Conclusions:
- Standardized TMS methodologies are essential for accurate hospitalist workflow assessment and longitudinal comparisons.
- A novel quality assessment tool highlights the need for improved study design in TMS research.
- Future research should incorporate validated tools, address multitasking, and explore metrics beyond productivity.
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