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Am J Ophthalmol. 2019 Mar 22. pii: S0002-9394(19)30120-5. doi: 10.1016/j.ajo.2019.03.014. [Epub ahead of print]

Time requirements of paper-based clinical workflows and after-hours documentation in a multi-specialty academic ophthalmology practice.

Author information

1
University of California San Diego (UCSD) Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, CA; UCSD Health Department of Biomedical Informatics, La Jolla, CA. Electronic address: S1baxter@ucsd.edu.
2
University of California San Diego (UCSD) Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, CA; UCSD Health Department of Biomedical Informatics, La Jolla, CA.
3
Oregon Health & Science University (OHSU) Department of Medical Informatics and Clinical Epidemiology, Portland, OR; Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR.
4
UCSD Health Department of Biomedical Informatics, La Jolla, CA; UCSD Department of Medicine, La Jolla, CA.
5
University of California San Diego (UCSD) Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, CA.
6
UCSD Health Department of Biomedical Informatics, La Jolla, CA.
7
UCSD Health Department of Biomedical Informatics, La Jolla, CA; UCSD Department of Medicine, La Jolla, CA; Veterans Administration San Diego Healthcare System Division of Health Services Research and Development, La Jolla, CA.

Abstract

PURPOSE:

To assess time requirements for patient encounters and estimate after-hours demands of paper-based clinical workflows in ophthalmology.

DESIGN:

Time-and-motion study with a structured survey METHODS:• SETTING: : Single academic ophthalmology department.

PARTICIPANTS AND OBSERVATION PROCEDURES:

Convenience sample of seven attending ophthalmologists from six subspecialties observed during 414 patient encounters for the time-motion analysis and twelve attending ophthalmologists for the survey.

MAIN OUTCOME MEASURES:

Total time spent by attending ophthalmologists per patient, and time spent on documentation, examination, and talking with patients. The survey assessed time requirements of documentation-related activities performed outside of scheduled clinic hours.

RESULTS:

Among the 7 attending ophthalmologists observed (6 men and 1 woman, mean (SD) age, 43.9 (7.1) years) during encounters with 414 patients (mean (SD) age of 57.8 (24.6) years), the mean (SD) total time spent per patient was 8.1 (4.8) minutes, with 2.8 (1.4) minutes (38%) for documentation, 1.2 (0.9) minutes (17%) for examination, and 3.3 (3.1) minutes (37%) for talking with patients. New patient evaluations required significantly more time than routine follow-up visits and post-operative visits. Higher clinical volumes were associated with less time per patient. Survey results indicated that paper-based documentation was associated with minimal after-hours work on weeknights and weekends.

CONCLUSIONS:

and Relevance: Paper-based documentation comprises a substantial portion of the total time spent for patient care in outpatient ophthalmology clinics but is associated with minimal after-hours work. Understanding paper-based clinical workflows may help inform targeted strategies for improving electronic health record use in ophthalmology.

PMID:
30910517
PMCID:
PMC6755078
[Available on 2020-09-22]
DOI:
10.1016/j.ajo.2019.03.014

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