Time Study: Acute Pediatric Therapy

Amy Swenson, PTHeather Winters, OT

Investigation of time use is required to more fully understand workflow and efficiency, time use of documentation systems, and effect on average productivity in acute pediatric therapy

CQI Question:

Anecdotal evidence suggests therapists spend more than the expected working hours per day to achieve current average productivity requirements

Annual employee satisfaction survey results suggest current productivity requirements and documentation issues may negatively impact quality of care, quality of documentation, efficiency, and employee satisfaction

Methods:

Time study of daily activities of two pediatric therapists (PT & OT)

Therapists completed daily data collection sheets for 3 months (11/08-1/09)

Sample Data Collection Sheet

Date 10:40am 7:15am 10:45am 7:20am 10:50am 7:25am 10:55am 7:30am 11am 7:35am 11:05am 7:40am 11:10am 7:45am 11:15am 7:50am 11:20am 7:55am 11:25am 8am 11:30am 8:05am 11:35am 8:10am 11:40am 8:15am 11:45am 8:20am 11:50am 8:25am 11:55am 8:30am 12:pm 8:35am 12:05pm 8:40am 12:10pm 8:45am 12:15pm 8:50am 12:20pm 8:55am 12:25pm 9am 12:30pm 9:05am 12:35pm 9:10am 12:40pm 9:15am 12:45pm 9:20am 12:50pm 9:25am 12:55pm 9:30am 1pm 9:35am 1:05pm 9:40am 1:10pm 9:45am 1:15pm 9:50am 1:20pm 9:55am 1:25pm 10am 1:30pm 10:05am 1:35pm 10:10am 1:40pm 10:15am 1:45pm 10:20am 1:50pm 10:25am 1:55pm 10:30am 2pm 10:35am 2:05pm

Double-click on sample form to open document for full review

Data Collection

Time use was tracked by the minute by category throughout each workday

Major categories: productive/billable vs nonproductive/nonbillable time

Productive Time

EvaluationTreatment

Nonproductive Time

SchedulingChart reviewCommunication with rehab teamTravel time to patient room/buildingNurse approvalDiscussion with nurse after session

Nonproductive Time

Waiting for patientFailed attemptsOrdering equipmentRetrieving equipment/suppliesSet-up for sessionClean-up from session

Nonproductive Time

DocumentationFamily educationNonbillable patient careComputer problemsMeetingsWork-related email

Nonproductive Time

CQI projectOrganizational time (I.e. making

copies, filing)Student timePersonal time (I.e. lunch, restroom,

making personal calls, socialization)

Time

Total time - personal time = work time

Work time = productive(billable) + nonproductive(nonbillable)

Productivity

Tracked:Total units of productivity# of evaluations & total evaluation

units# of treatment sessions & total

treatment units# of failed attempts

Documentation

Tracked amount of nonproductive time spent on documentation

Documentation time per unit of productivity

Documentation time per working hour

Location/Day

Tracked work location Inpatient Outpatient (DOT clinics, preschools,

OHO)Some days we do it all…!

Tracked day of the week

Results:Time Study Data Tables

Section 1: Time Use by Major Category and Subcategory per Therapist/Type of Day Table 1: Average total time, work time, and time by major category (in hours) Category OT: Weekdays PT: All Days PT: Weekdays PT: Weekend Days Total time 9.5 9.2 9.4 7.8 Work time 9.0 8.7 8.9 7.4 Productive work time 4.0 3.7 3.7 3.3 Non-productive work time 5.0 5.0 5.2 4.1 Table 2: Average time/day per subcategory by type of day (in minutes) Subcategory OT: Weekdays PT: All Days PT: Weekdays PT: Weekend Days Scheduling 15 9 8 13 Chart review 25 36 36 36 Communication with team 7 17 17 13 Travel between patients 11 30 32 18 Nurse approval 5 12 12 15 Nurse discussion 6 6 6 5 Wait for patient 1 5 5 2 Failed attempt 7 4 4 5 Order equipment 0 1 0.5 2 Get equipment 4 3 3 7 Setup 6 1 1 1 Cleanup 4 4 3 4 Evaluation 32 36 39 17 Treatment 206 183 183 183 Documentation 126 135 139 107 Family education 11 2 2 3 Non-billable patient care 13 5 6 1 Computer problems 3 2 2 0 Meetings 37 11 12 0 Personal time 3 4 4 1 Lunch 25 28 29 20 Work email 12 5 6 1 CQI project 8 5 5 4 Organization 0 10 10 8 Student 0 0 0 0

Double-click on sample data tables to open document for full review

Assessment:

Productivity requirements at the time of this study were higher than these therapists were achieving in an 8-hour workday

Therapists start early, work through lunch, stay late, complete work from home, and/or complete work on off-days to improve productivity and attempt to meet scheduled patients’ needs

InpatientProductivity is lower than in outpatient settingMore time spent on documentationOther major nonproductive time is spent in

scheduling, chart review, communication with team, and travel between patients

# and time spent on failed attempts not the major factor, although more than outpatient

Outpatient

Able to achieve current productivity requirements more often in outpatient setting

Less time spent on documentation Fewer failed attempts

Both settings

Documentation takes up majority of nonproductive worktime

Increasing time on documentation as week progresses from Monday to Friday, possibly due to deferred documentation…?

Recommendations:

Information collected in this study was submitted to pediatric therapy managers for use in developing new productivity requirements and to direct further investigation into time use

Productivity requirements should be lowered for days therapists cover the inpatient setting

Known estimates of nonproductive time that is essential to support productive time should be accounted for when assessing productivity

Team should investigate methods of improving efficiency to increase productivity in major areas of nonproductive time in the inpatient setting:DocumentationSchedulingChart reviewCommunication with team membersTravel between patients

Additional time use studies by other therapists in inpatient/outpatient, by floor or unit, by therapist experience level, full-time vs part-time, or by time of year

May assist with departmental planning, budgeting, and training

Pediatric Therapy Time Study

For questions or comments, please contact Amy Swenson, PT

(615)835-0656