gms | German Medical Science

Kongress Medizin und Gesellschaft 2007

17. bis 21.09.2007, Augsburg

Time for documentation versus time for direct patient care: results of a work sampling analysis

Meeting Abstract

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  • Elske Ammenwerth - UMIT - Private Universität für Gesundheitswissenschaften, Med. Informatik und Technik Tirol, Hall in Tirol
  • Hans-Peter Spötl - UMIT - Private Universität für Gesundheitswissenschaften, Med. Informatik und Technik Tirol, Hall in Tirol

Kongress Medizin und Gesellschaft 2007. Augsburg, 17.-21.09.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07gmds010

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Veröffentlicht: 6. September 2007

© 2007 Ammenwerth et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Introduction: Health care professionals are often complaining about high documentation efforts. Only few scientific studies tried to objectively measure the real time needed for documentation for physicians [1], [2]. The aim of our study was therefore to measure the time needed for documentation.

Methods: We selected work-sampling (instead of time-motion analysis) as it provides a quick estimation of working patterns. Work-sampling comprises of the following steps [3]: First, identification of working categories. Second, conduction of a pilot study for sample size calculation. Third, conduction and analysis of main study. Our analysis was conducted at a 200-beds-hospital in Tyrol in December-2006. The study was conducted at two wards of the Department of Internal Medicine. On each ward, four physicians were observed.

Results: The working categories were derived from a literature search and confirmed by observations and interviews. From the 35 categories, 19 describing documentation activities. Results from the pilot study showed that around 2.170 observations would be needed for each ward. The study therefore went over 5 days à 8 hours on each ward with observation of activities every 2 minutes. On each ward, all four physicians were observed in parallel by one observer. Overall, 5.500 observations were documented. Results show that documentation takes between 8.5% and 55.5% of the daily working time of a physician (27.8% ± 10.5%).

Discussion: The hospital management had stated before the study that documentation should not exceed 30% of working time. While the mean is just below this threshold, each of the 8 observed physicians spend at least one day (from five) with more then 30% of their time for documentation. In a questionnaire-based self-assessment of physicians, [4] found that physician document around 40% a day. Our results, somewhat lower, are based on objective data and confirm the high documentation efforts of physicians.


Gottschalk A, Flocke SA. Time spent in face-to-face patient care and work outside the examination room. Ann Fam Med 2005; 3(6):488-493.
Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12(5):505-516
Sittig DF. Work Sampling: A Statistical Approach to Evaluation of the Effect of Computers on Work Patterns in The Healthcare Industry. Methods of Information in Medicine 1993;32(2):167-174.
Deutsches Krankenhausinstitut. Ärztlicher Dokumentationsaufwand. Schriftreihe Wissenschaft und Praxis der Krankenhausökonomie Band 11. Düsseldorf: Deutsche Krankenhaus Verlagsgesellschaft. ISBN 3-935762-22-4