Paperwork Versus Patient Care: A Nationwide Survey of Residents' Perceptions of Clinical Documentation Requirements and Patient Care

Abstract

Background The current health care system requires a substantial amount of documentation by physicians, potentially limiting time spent on patient care. Objective We sought to explore trainees' perceptions of their clinical documentation requirements and the relationship between time spent on clinical documentation versus time available for patient care. Methods An anonymous, online survey was sent to trainees in all postgraduate years of training and specialties in Accreditation Council for Graduate Medical Education–accredited programs. Results Over a 2-month time frame, 1515 trainees in 24 specialties completed the survey. Most (92%) reported that documentation obligations are excessive, that time spent with patients has been compromised by this (90%), and that the amount of clinical documentation has had a negative effect on patient care (73%). Most residents and fellows reported feeling rushed and frustrated because of these documentation demands. They also reported that time spent on these tasks decreased their time available for teaching others and reduced the quality of their education. Respondents reported spending more time on clinical documentation than on direct patient care (P < .001). Conclusions Trainees' current clinical documentation workload may be a barrier to optimal patient care and to resident and fellow education. Residents and fellows report that clinical documentation duties are onerous, and there is a perceived negative effect on time spent with patients, overall quality of patient care, physician well-being, time available for teaching, and quality of resident education.

Racing Against the Clock: Internal Medicine Residents' Time Spent On Electronic Health Records

“…2 Furthermore, a nationwide survey revealed that residents' perceptions of the time devoted to documentation were generally negative; residents felt that clinical documentation took time away from education, patient care, and more importantly, motivation to provide high-quality care. 10 This has been linked to reduced resident satisfaction and increased burnout. 10,[20][21][22] Therefore, to address resident satisfaction and thus improve motivation to provide patient-centered quality care, reducing the time residents spend on clinical documentation should be a priority.…”

“…10 This has been linked to reduced resident satisfaction and increased burnout. 10,[20][21][22] Therefore, to address resident satisfaction and thus improve motivation to provide patient-centered quality care, reducing the time residents spend on clinical documentation should be a priority. Limitations of our study include its single center, observational, and retrospective format.…”

Athletic Trainers' Reasons for and Mechanics of Documenting Patient Care: A Report From the Athletic Training Practice-Based Research Network

“…5,6 These other health care professionals are also typically situated in hospital and pharmacy settings, which are quite different from the usual collegiate and secondary school athletic training environments. 5,7 Even facilities, budgets, staffing, and administrative structures may vary within the same type of athletic training practice setting, such as secondary schools.…”

Prioritizing Paperwork Over Patient Care: Why Can't We Do Both?

“…9,10 In a 2013 poll, 92% of residents reported that clinical documentation obligations are excessive, and 73% of residents reported compromises in patient care by these requirements. 11 Among internal medicine residents surveyed in 2006, two-thirds reported spending more than 4 hours daily on documentation, while only one-third recounted spending this amount of time with patients themselves. 1 For every 3 minutes spent face-to-face with a patient, 1 minute is needed for clerical tasks, with charting comprising the brunt of this work.…”