A clever little study was published last month in the Archives of Internal Medicine, and it – plus the fact that I’ve just started a stint as ward attending – prompted me to think about the importance of managing a set of tasks in the hospital. In my quarter-century of mentoring residents and faculty, I can’t think of an area in which the gulf between what people should do and what they actually do is larger, nor one in which improving performance yields more tangible rewards.
In this blog, I’ll begin by reviewing the Archives study and then consider its lessons for time management, particularly on the wards. In my next post, I’ll describe – just in time for New Year’s resolutions – a little technique I’ve developed that has helped me and others complete tasks that feel overwhelmingly large.
In the Archives paper, a research team led by informatician Michael Cohen of the University of Michigan set out to tackle the “portfolio effect”: how to allocate scarce time when discussing multiple patients. Cohen’s team videotaped 23 end-of-week resident sign-outs of ICU patients; on average, 11 patients were signed out per session, and each session lasted about 27 minutes. The patients were reviewed in bed order, not based on severity of illness or anything less random than where they happened to be lying in the ICU. (In my experience, this location-based sequencing is the most common method of organizing sign-out; going in alphabetical order of patients’ last names is a close second.)
Try to guess which patients were discussed at most length by the residents. The sickest? The oldest? The youngest? Those with the most complex social issues? Patients who were potentially eligible for ICU discharge that day?