[A day in the life of a medical resident on the ward]

OBJECTIVE

To investigate how internal medicine residents allocate their time during a hospital dayshift on the wards.

DESIGN

Prospective observational cohort study (time and motion study).

METHODS

Data were collected from 36 internal medicine residents working at the Internal Medicine Department of the Academic Medical Centre in Amsterdam, the Netherlands. Trained observers monitored 22 residents using a newly developed smartphone-application, registering their dayshift activities (meetings and education, direct patient contact, administrative tasks, lunch/break, other) and location (workstation, conference room, ward and patient rooms, other). Data of 14 residents on work-related activities during after-hours in the hospital and at home were collected through a questionnaire.

RESULTS

Residents were observed for a total of 210 hours. The average workday encompassed 9.5 hours. During this dayshift, residents spent an average of 38% of their time on administrative tasks, and 37% on interprofessional consultation and educational activities. Direct patient/family contact accounted for 13% of the workday. After the evening handover at 5 pm, on average another 80 minutes of work was performed in the hospital, of which 73 minutes (91%) entailed administration. At home, they spent on average another 52 minutes on patient care related work, of which 51 minutes (98%) consisted of administration.

CONCLUSION

The internal medicine residents on the ward spend most of their dayshift on indirect patient care. This comprises mostly computer-based administrative tasks. After the dayshift, many residents continue to work in their own time to finish remaining paperwork. Study limitations are the limited total number of monitored residents, the total observation time and possible self-report bias.

High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial

Objectives

To determine whether there is a difference in frequency and clinical relevance of incidental findings detected by total-body computed tomography scanning (TBCT) compared to those by the standard work-up (STWU) with selective computed tomography (CT) scanning.

Methods

Trauma patients from five trauma centres were randomized between April 2011 and January 2014 to TBCT imaging or STWU consisting of conventional imaging with selective CT scanning. Incidental findings were divided into three categories: 1) major finding, may cause mortality; 2) moderate finding, may cause morbidity; and 3) minor finding, hardly relevant. Generalized estimating equations were applied to assess differences in incidental findings.

Results

In total, 1083 patients were enrolled, of which 541 patients (49.9 %) were randomized for TBCT and 542 patients (50.1 %) for STWU. Major findings were detected in 23 patients (4.3 %) in the TBCT group compared to 9 patients (1.7 %) in the STWU group (adjusted rate ratio 2.851; 95%CI 1.337–6.077; p < 0.007). Findings of moderate relevance were detected in 120 patients (22.2 %) in the TBCT group compared to 86 patients (15.9 %) in the STWU group (adjusted rate ratio 1.421; 95%CI 1.088–1.854; p < 0.010).

Conclusions

Compared to selective CT scanning, more patients with clinically relevant incidental findings can be expected by TBCT scanning.

Key points

• Total-body CT scanning in trauma results in 1.5 times more incidental findings.

• Evaluation by TBCT in trauma results in more patients with incidental findings.

• In every category of clinical relevance, TBCT detects more incidental findings.