Effect of Hospitalist Workload on the Quality and Efficiency of Care

Elliott, Daniel; Young, Robert S.; Brice, Joanne; Aguiar, Ruth; Kolm, Paul

doi:10.1001/jamainternmed.2014.300

Cited by 137 publications

(146 citation statements)

References 30 publications

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“…Increased physician workload has been hypothesized to lead to excess errors, including delayed response to abnormal test results and prescribing errors, which have the potential to lead to increased morbidity and mortality (18). While prior studies have examined the role of handoffs and the impact of ward structure changes in the most recent duty hour regulations (19–20), the specific impact of resident hours on patient care has not been well studied.…”

Section: Discussionmentioning

confidence: 99%

Patient Outcomes when Housestaff Exceed 80 Hours per Week

Ouyang

Chen

Krishnan

et al. 2016

The American Journal of Medicine

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Purpose It has been posited that high workload and long work hours for trainees could affect the quality and efficiency of patient care. Duty hour restrictions seek to balance patient care and resident education by limiting resident work hours. Through a retrospective cohort study, we investigate whether patient care on an inpatient general medicine service at a large academic medical center is impacted when housestaff work greater than eighty hours per week Methods We identified all admissions to a housestaff-run general medicine service between June 25, 2013 and June 29, 2014. Each hospitalization was classified by whether or not the patient was admitted by housestaff who have worked more than eighty hours a week during their hospitalization. Housestaff computer activity and duty hours were calculated by institutional electronic heath record audit, as well as length of stay and a composite of in-hospital mortality, ICU transfer rate, and 30-day readmission rate. Results We identified 4,767 hospitalizations by 3,450 unique patients; of which 40.9% of hospitalizations were managed by housestaff who worked more than eighty hours that week during their hospitalization. There was a significantly higher rate of the composite outcome (19.2% vs. 16.7%, p = 0.031) for patients admitted by housestaff working more than eighty hours a week during their hospitalization. We found a statistically significant higher length of stay (5.12 vs. 4.66 days, p = 0.048) and rate of ICU transfer (3.18% vs. 2.38%, p = 0.029). There was no statistically significant difference in 30-day readmission rate (13.7% vs. 12.8%, p = 0.395), or in-hospital mortality rate (3.18% vs. 2.42%, p = 0.115).There was no correlation with team census on admission and patient outcomes. Conclusions Patients taken care of by housestaff working more than eighty hours a week had increased length of stay and number of ICU transfers. There was no association between resident work-hours and patient in-hospital mortality or 30-day readmission rate.

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Section: Discussionmentioning

confidence: 99%

Patient Outcomes when Housestaff Exceed 80 Hours per Week

Ouyang

Chen

Krishnan

et al. 2016

The American Journal of Medicine

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“…We also calculated mean daily outpatient relative value units (RVUs) generated as a measure of outpatient workload while the attending was supervising the inpatient service. Similar measures of workload have been used in previous research . Attending physicians in this study functioned as hospitalists during their time supervising the teaching services; that is, they were not routinely assigned to any outpatient responsibilities.…”

Section: Methodsmentioning

confidence: 99%

Associations between attending physician workload, teaching effectiveness, and patient safety

Wingo

Halvorsen

Beckman

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Prior studies suggest that high workload among attending physicians may be associated with reduced teaching effectiveness and poor patient outcomes, but these relationships have not been investigated using objective measures of workload and safety. OBJECTIVE To examine associations between attending workload, teaching effectiveness, and patient safety, hypothesizing that higher workload would be associated with lower teaching effectiveness and negative patient outcomes. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective study of 69,386 teaching evaluation items submitted by 543 internal medicine residents for 107 attending physicians who supervised inpatient teaching services from July 2, 2005 to July 1, 2011. MEASUREMENTS Attending workload measures included hospital service census, patient length of stay, daily admissions, daily discharges, and concurrent outpatient duties. Teaching effectiveness was measured using residents' evaluations of attendings. Patient outcomes considered were applicable patient safety indicators (PSIs), intensive care unit transfers, cardiopulmonary resuscitation/rapid response team calls, and patient deaths. Mixed linear models and generalized linear regression models were used for statistical analysis. RESULTS Workload measures of midnight census and daily discharges were associated with lower teaching evaluation scores (both β = −0.026, P < 0.0001). The number of daily admissions was associated with higher teaching scores (β = 0.021, P = 0.001) and increased PSIs (odds ratio = 1.81, P = 0.0001). CONCLUSION Several measures of attending physician workload were associated with slightly lower teaching effectiveness, and patient safety may be compromised when teams are managing new admissions. Ongoing efforts by residency programs to optimize the learning environment should include strategies to manage the workload of supervising attendings. Journal of Hospital Medicine 2016;11:169–173. © 2016 Society of Hospital Medicine

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“…), clinical proficiency (Elliott et al. ), and work–home balance (Keeton et al. ), thus worsening vulnerability to burnout (Dyrbye et al.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Resilience among Employed Physicians and Mid‐Level Practitioners in Upstate New York

Waddimba

Scribani

Hasbrouck

et al. 2016

Health Services Research

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Objective. To investigate the factors associated with resilience among medical professionals. Data Sources/Study Setting. Administrative information from a rural health care network (1 academic medical center, 6 hospitals, 31 clinics, and 20 school health centers) was triangulated with self-report data from 308 respondents (response rate = 65.1 percent) to a 9/2013-1/2014 survey among practitioners serving a nine-county 5,600-square-mile area. Study Design. A cross-sectional questionnaire survey comprising valid measures of resilience, practice meaningfulness, satisfaction, and risk/uncertainty intolerance, nested within a prospective, community-based project. Data Collection/Extraction Methods. The sampling frame included practitioners on institutional payroll, excluding voluntary/involuntary attritions and advisory board/research team members. In multivariable mixed-effects models, we regressed full-range and high-/low-resilience scores on demographics, professional satisfaction, workplace needs, risk/uncertainty intolerance, and service unit characteristics. Principal Findings. Relational needs, uncertainty intolerance, satisfaction ≥75 percent of the time, number of practitioners on a unit, and workload were significantly associated with resilience. Higher scores were most strongly associated with uncertainty tolerance, satisfaction, and practitioner numbers. Practitioner/unit demographics were mostly nonsignificant. Conclusions. More resilient practitioners experienced frequent satisfaction, relational needs gratification, better uncertainty tolerance, lighter workloads, and practiced on units with more colleagues. Further studies should investigate well-being interventions based on these mutable factors.

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Effect of Hospitalist Workload on the Quality and Efficiency of Care

Cited by 137 publications

References 30 publications

Patient Outcomes when Housestaff Exceed 80 Hours per Week

Patient Outcomes when Housestaff Exceed 80 Hours per Week

Associations between attending physician workload, teaching effectiveness, and patient safety

Resilience among Employed Physicians and Mid‐Level Practitioners in Upstate New York

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