Currently submitted to: JMIR Nursing
Date Submitted: Jul 29, 2019
Open Peer Review Period: Aug 1, 2019 - Sep 26, 2019
(currently open for review)
Understanding Nursing Workflow for Inpatient Education Delivery: A Time and Motion Study
Diabetes self-management education and support (DSMES) improves diabetes-related outcomes, but many persons living with diabetes do not receive DSMES. Adults with diabetes have high hospitalization rates, so hospital stays may present an opportunity for diabetes education. Nurses, supported by patient care technicians (PCTs), are typically responsible for delivering patient education but often do not have time. Using technology to support education delivery in the hospital is one potential solution.
The aim of the current study was to evaluate workflow considerations for implementing a diabetes education program on a tablet computer in the hospital setting within existing nursing unit workflow with existing unit staff.
We conducted a time and motion study of nurses and PCTs on three medical-surgical units of a large urban tertiary care hospital. Observations were conducted in two-hour blocks by five trained observers. During each observation, a single observer shadowed a single nurse or PCT and recorded the tasks, locations, and their durations. Observations were recorded using a web-based time and motion data collection tool. Percentage of time spent on a task and in a location and mean duration of task and location sessions were calculated. In addition, the number of tasks and locations per hour, number of patient rooms visited per hour, and mean time between visits to a given patient room were determined.
Nurses spent approximately one third of their time in direct patient care and much of their time (60%) on the unit, but not in a patient room. Compared to nurses, PCTs spent a significantly greater percentage of time in direct patient care (42%; P = .001). Nurses averaged 16.2 tasks per hour, while PCTs averaged 18.2. The mean length of a direct patient care session was 3:42 minutes for nurses and 3:02 minutes for PCTs. For nurses, 56% of task durations were two minutes or less, and 38% were one minute or less. For PCTs, 62% were two minutes or less and 44% were one minute or less. Nurses visited 5.3 and PCTs 9.4 patient rooms per hour. The mean time between nurse visits to a given room was 37:15 minutes and between PCT visits to a given room 33:28 minutes.
The workflow of nurses and PCTs, constantly in and out of patient rooms, suggests an opportunity for delivering a tablet to the patient bedside. The average time between visits to a given room is consistent with bringing the tablet to a patient in one visit and retrieving it at the next. However, the relatively short duration of direct patient care sessions could potentially limit the ability of nurses and PCTs to spend much time with each patient on instruction in the technology platform or the content.
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