Heavy physician workload hurts patients

Hospitalists with excess patient encounters reported ordering unnecessary tests, poor patient satisfaction
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Heavy hospitalist workloads can hurt patient care, according to a new survey published in the JAMA Internal Medicine. Attending physicians with excess patient encounters said they were more likely to order unnecessary tests, have poorer patient satisfaction and see worse patient outcomes.

Using data from the online physician network QuantiaMD, Johns Hopkins researchers found physicians said they could safely see 15 patients per shift. However, 40 percent said their typical inpatient census exceeded safe levels at least once a month, and more than a third (36 percent) said it happened weekly.

Hospitalists said the number of patients they saw or were expected to see led to the following:

Unable to fully discuss treatment options with the patient/family

25%

Delayed admissions and discharges

22%

Ordered unnecessary tests, procedures, consultations

22%

Worsened patient satisfaction

19%

Increased readmissions

14%

Worsened overall quality of care

12%

Made a treatment or medication error (not due to lack of experience or knowledge)

7%

Morbidity or complications

7%

Mortality

5%

The article points to disturbing statistics about the effects of workload burdens on hospitalists.

Although the industry, particularly with rules from the Accreditation Council for Graduate Medical Education, regulates resident workload to reduce medical errors, no such work-hour regulations universally exist for attendings or other clinicians, though 14 states have legislation or regulations for nursing staffing.

Ironically, the limitations on resident work hours have likely caused increased workloads for attending physicians.

Researchers said, "Given the large number of patients cared for by hospitalists, the frequency with which workload exceeds safe levels, and the perceived impact of workload on patient outcomes, hospital administrators, researchers, and policymakers should focus attention on attending physician workload," MedPage Today reported.

For more information:
- check out the article abstract
- read the MedPage Today article

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