A significant body of research demonstrates that more nurse time at the bedside enhances quality of patient care and staff satisfaction. And, numerous studies show that nurses spend considerable time in non-value-added activities such as “hunting and gathering supplies,” documentation, and other administrative duties. A number of the changes to be implemented in the Transforming Care at the Bedside Collaborative will focus on increasing nurse and other clinician time with patients and reducing waste and non-value-added work. 

IHI strongly recommends that teams purchase and use PDAs (personal digital assistants) to help them assess how all nurses on a particular unit are spending their time, and to track how the changes implemented in this Collaborative affect nurse time at the bedside. 

PDAs allow for an inexpensive, unintrusive alternative to time and motion studies. They enable a measurement technique, called “work sampling,” which is broadly defined as the application of statistical sampling techniques to the study of work activities. The PDA devices automatically randomize alarms and observations. Since nurse activity is complex with significant multitasking, it is not always possible for an observer to accurately classify the work that is being performed. Self-sampling is a method in which a nurse enters the data directly into the data collection device, ensuring that the most accurate work category is selected. Some of the primary advantages of work sampling are as follows:

• Work sampling is less expensive than continuous observation techniques
• Self-sampling is possible with minimal specialized training
• The number of observations can be adjusted to meet desired levels of precision
• Work/self-sampling results in less anxiety and agitation among staff than continuous observation
• There is minimal interference with the normal routine of the staff

It is important to note that there is an additional cost of $5,680 associated with the purchase of two PDAs, licensing of related software, and technical assistance and training. Although purchase of PDAs is not mandatory, IHI does strongly recommend their use for this collaborative. In addition, the PDAs may be programmed to serve many additional functions, including scheduling and contact management.

Please contact Angela DiGioia, the Project Manager for the Transforming Care at the Bedside Collaborative, at adigioia@ihi.org, with any questions or concerns about the PDA Time Study Tool.