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Driver D, Berlacher M, Harder S, Oakman N, Warsi M, Chu ES. The Inpatient Experience of Emerging Adults: Transitioning From Pediatric to Adult Care. J Patient Exp 2022; 9:23743735221133652. [PMID: 36311907 PMCID: PMC9597024 DOI: 10.1177/23743735221133652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The pediatric-to-adult care transition has been correlated with worse outcomes,
including increased mortality. Emerging adults transitioning from child-specific
healthcare facilities to adult hospitals encounter marked differences in
environment, culture, and processes of care. Accordingly, emerging adults may
experience care differently than other hospitalized adults. We performed a
retrospective cohort study of patients admitted to a large urban safety net
hospital and compared all domains of patient experience between patients in 3
cohorts: ages 18 to 21, 22 to 25, and 26 years and older. We found that patient
experience for emerging adults aged 18 to 21, and, to a lesser extent, aged 22
to 25, was significantly and substantially worse as compared to adults aged 26
and older. The domains of worsened experience were widespread and profound, with
a 38-percentile difference in overall experience between emerging adults and
established adults. While emerging adults experienced care worse in nearly all
domains measured, the greatest differences were found in those pertinent to
relationships between patients and care providers, suggesting a substantial
deficit in our understanding of the preferences and values of emerging
adults.
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Affiliation(s)
- Daniel Driver
- Department of Internal Medicine, University of Texas Southwestern
Medical School, Dallas, TX, USA,Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA,Daniel Driver, University of Texas
Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390-8811, USA.
| | - Michelle Berlacher
- Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA,Department of Pediatrics, Division of Internal Medicine and
Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Stephen Harder
- Department of Internal Medicine, University of Texas Southwestern
Medical School, Dallas, TX, USA,Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA
| | - Nicole Oakman
- Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA,Department of Pediatrics, Division of Internal Medicine and
Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Maryam Warsi
- Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA
| | - Eugene S Chu
- Department of Internal Medicine, University of Texas Southwestern
Medical School, Dallas, TX, USA,Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA
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Djulbegovic M, Chen K, Cohen AB, Heacock D, Canavan M, Cushing W, Agarwal R, Simonov M, Chaudhry SI. Associations between hospitalist physician workload, length of stay, and return to the hospital. J Hosp Med 2022; 17:445-455. [PMID: 35662410 PMCID: PMC9248905 DOI: 10.1002/jhm.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/03/2022] [Accepted: 04/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Hospitalist physicians' workload-the total number of patients they care for daily-is rising in the U.S. Hospitalists report that increased workload negatively affects patients care. OBJECTIVE Measure the associations between hospitalist physicians' workload and clinical outcomes. DESIGN, SETTINGS, AND PARTICIPANTS Observational study, using electronic health record (EHR) data, of adults hospitalized on the hospitalist service at Yale-New Haven Hospital from 2015-2018. MAIN OUTCOME AND MEASURES We defined hospitalists' workload as the number of patients they cared for on the first full hospital day of a given patient's encounter. We used multilevel Poisson and logistic regression to examine associations between workload and length of stay (LOS), return to the Emergency Department (ED), and readmission. We adjusted for sociodemographic factors, patient complexity and severity of illness, and weekend admission (for LOS) or discharge (for ED visits or readmission). RESULTS We analyzed 38,141 hospitalizations. Median patient age was 64 years (IQR 51-78 years), 53% were female, and 34% were nonwhite. Mean workload was 15 patients (SD 3 patients; range 10-34 patients). LOS was prolonged by 0.05 days (95% CI 0.02, 0.08; p(0.001) when comparing the 75th workload percentile (16 patients) to the 25th workload percentile (13 patients). There were no associations between workload and ED visits or readmission within 7 and 30 days. CONCLUSIONS There was a statistically significant but modest relationship between workload and LOS; workload was not associated with ED visits or readmissions.Given clinical reports of the deleterious effects of increased hospitalist workload, there is a need for prospective research assessing a range of outcomes, beyond those measurable in contemporary EHR data.
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Affiliation(s)
- Mia Djulbegovic
- National Clinician Scholars Program, Yale University School
of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Healthcare System, West Haven,
Connecticut, USA
- Department of Medicine, Division of Hematology &
Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,
USA
| | - Kevin Chen
- National Clinician Scholars Program, Yale University School
of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Healthcare System, West Haven,
Connecticut, USA
- Division of General Internal Medicine and Clinical
Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Andrew B. Cohen
- Veterans Affairs Connecticut Healthcare System, West Haven,
Connecticut, USA
- Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, USA
| | | | - Maureen Canavan
- National Clinician Scholars Program, Yale University School
of Medicine, New Haven, Connecticut, USA
- Yale Cancer Outcomes, Public Policy and Effectiveness
Research (COPPER) Center, Yale School of Medicine, Department of Internal Medicine,
New Haven, Connecticut, USA
| | | | - Ritu Agarwal
- Joint Data Analyst Team, Yale New Haven Health System, New
Haven, CT
- Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, USA
| | | | - Sarwat I. Chaudhry
- National Clinician Scholars Program, Yale University School
of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, USA
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Li D, Hu Y, Liu S, Lu C, Zhang Y, Zhou J, Li J, Zhang Z. Developing an Integrated Evaluation Model for Physician Comprehensive Workload Tethered to Outpatient Practice: An Empirical Study From China. Front Public Health 2022; 10:847613. [PMID: 35664107 PMCID: PMC9162480 DOI: 10.3389/fpubh.2022.847613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies, often simply using either objective workload or mental workload as a measure of physician workload in various healthcare settings might have failed to comprehensively reflect the real workload among physicians. Despite this, there is little research that further explores a comprehensive workload evaluation framework with the integration of objective workload and mental workload to describe their comprehensive workload. Methods A comprehensive evaluation framework for physician workload was proposed based on the combination of objective workload and task-level mental workload also with the consideration of quality of provided medical services and served patient complexity; and accordingly, an integrated evaluation model for physician comprehensive workload (PCW) tethered to outpatient practice was developed and further applied to perform a PCW analysis using cross-sectional data on outpatient workload of 1,934 physicians mainly from 24 hospitals in 6 provinces in Eastern, Central, and Western China. Multiple linear regression and multinomial logistic regression analyses were established to identify significant factors influencing the PCW. Results Overall, the average score of PCW tethered to outpatient practice Chinese physicians experienced was 811.30 (SD=494.98) with concentrating on between 200 and 1,200. Physicians who were female, from Eastern or Western China, and those who worked >60 h per week and longer outpatient hours per week were more likely to experience a higher PCW. 11.2% of participating physicians were identified as very high PCW physicians, compared with 11.6% as low PCW physicians, 45.5% as medium PCW physicians and 30.7% as high PCW physicians. Those who were female, older, from Western China, those who had lower educational levels, lower professional titles and longer working years in the current institution, and those who worked in tertiary A hospitals and Internal or Surgical, and worked >60 h per week and longer outpatient hours per week were more likely to be very high PCW physicians. Conclusions Our work has a potential application for comprehensively assessing physician workload tethered to outpatient practice and could provide a solid foundation for hospital managers to further accurately determine and identify physicians with high workload, who would otherwise be missed in either objective workload or mental workload.
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Affiliation(s)
- Dehe Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yinhuan Hu
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuntao Lu
- Jingmen No. 2 People's Hospital, Jingmen, China
| | - Yeyan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinghan Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zemiao Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Arogyaswamy S, Vukovic N, Keniston A, Apgar S, Bowden K, Kantor MA, Diaz M, McBeth L, Burden M. The Impact of Hospital Capacity Strain: a Qualitative Analysis of Experience and Solutions at 13 Academic Medical Centers. J Gen Intern Med 2022; 37:1463-1474. [PMID: 34902096 PMCID: PMC8667526 DOI: 10.1007/s11606-021-07106-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospital capacity strain impacts quality of care and hospital throughput and may also impact the well being of clinical staff and teams as well as their ability to do their job. Institutions have implemented a wide array of tactics to help manage hospital capacity strain with variable success. OBJECTIVE Through qualitative interviews, our study explored interventions used to address hospital capacity strain and the perceived impact of these interventions, as well as how hospital capacity strain impacts patients, the workforce, and other institutional priorities. DESIGN, SETTING, AND PARTICIPANTS Qualitative study utilizing semi-structured interviews at 13 large urban academic medical centers across the USA from June 21, 2019, to August 22, 2019 (pre-COVID-19). Interviews were recorded, professionally transcribed verbatim, coded, and then analyzed using a mixed inductive and deductive method at the semantic level. MAIN OUTCOME MEASURES Themes and subthemes of semi-structured interviews were identified. RESULTS Twenty-nine hospitalist leaders and hospital leaders were interviewed. Across the 13 sites, a multitude of provider, care team, and institutional tactics were implemented with perceived variable success. While there was some agreement between hospitalist leaders and hospital leaders, there was also some disagreement about the perceived successes of the various tactics deployed. We found three main themes: (1) hospital capacity strain is complex and difficult to predict, (2) the interventions that were perceived to have worked the best when facing strain were to ensure appropriate resources; however, less costly solutions were often deployed and this may lead to unanticipated negative consequences, and (3) hospital capacity strain and the tactics deployed may negatively impact the workforce and can lead to conflict. CONCLUSIONS While institutions have employed many different tactics to manage hospital capacity strain and see this as a priority, tactics seen as having the highest yield are often not the first employed.
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Affiliation(s)
| | | | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Sarah Apgar
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
| | - Kasey Bowden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Molly A Kantor
- Division of Hospital Medicine, University of California, San Francisco, CA, USA
| | - Manuel Diaz
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
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Guan X, Ni B, Zhang J, Zhu D, Cai Z, Meng W, Shi L, Ross-Degnan D. Association Between Physicians' Workload and Prescribing Quality in One Tertiary Hospital in China. J Patient Saf 2021; 17:e1860-e1865. [PMID: 32773646 DOI: 10.1097/pts.0000000000000753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alarming increasing trends in physician workload have attracted much attention in recent years. Heavy workload may compromise the quality of medication use. Previous studies have identified a series of factors contributing to inappropriate prescribing; however, there is no demonstrated evidence supporting an association between workload and the appropriateness of physicians' prescriptions in China. This study aimed to investigate the relationship between physician workload and prescription quality in a tertiary hospital in Beijing, China. METHODS Our study was a single-center, retrospective study, with all outpatient electronic health records extracted from hospital information system of a tertiary hospital in Beijing from July 1 to November 30, 2015. We used outpatient volume in each 5-hour shift as the measure of physician workload. The evaluation of prescribing quality was based on the Rational Drug Use System. Generalized linear models with a γ distribution and a log link were used to explore factors associated with inappropriate prescribing, and we undertook a series of robustness tests with respect to different exclusion criteria. RESULTS A total of 457,784 prescriptions from 502 physicians were included in the study. Physicians had an average workload of 34.3 (±19.8) patients per shift, and the mean rate of inappropriate prescribing per shift was 14.1% (±14.6%). Higher rates of inappropriate prescribing were associated with heavier workloads (P < 0.001). Physicians who worked in the afternoon, chief physicians, those working in surgical department, males, and those with more than 20-year experience had higher rates of inappropriate prescribing with increasing workload. CONCLUSIONS Heavier workload was associated with higher risk of prescribing inappropriately. It requires great efforts to determine optimal physician workloads and mitigate the potential adverse effects on the prescription quality.
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Affiliation(s)
| | - Bingyu Ni
- From the Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences
| | - Jingyuan Zhang
- From the Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences
| | | | | | - Wenshuang Meng
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | | | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Astik GJ, Kulkarni N, Cyrus RM, Yeh C, O'Leary KJ. Implementation of a triage nurse role and the effect on hospitalist workload. Hosp Pract (1995) 2021; 49:336-340. [PMID: 34170803 DOI: 10.1080/21548331.2021.1949169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Hospital medicine groups vary staffing models to match available workforce with expected patient volumes and acuity. Larger groups often assign a single hospitalist to triage pager duty which can be burdensome due to frequent interruptions and multitasking. We introduced a new role, the Triage nurse, to hold the triage pager and distribute patients. We sought to determine the effect of this Triage Nurse on the perceived workload of hospitalists and frequency of pages. METHODS We partnered with our patient throughput department to implement the Triage Nurse role who took the responsibility of tracking and distributing admissions among three admitting physicians along with coordinating report. We used the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) to measure perceived workload and accessed pager logs of admitters for 3 months before and after implementation. RESULTS Overall, 50 of an expected 67 NASA-TLX surveys (74.6%) were returned in the pre-intervention period and 64 of 92 (69.6%) were returned in the post-intervention period. We found a statistically significant reduction in the domains of physical demand, temporal demand, effort and frustration from pre- to post-intervention periods (p < 0.01). There was also a significant decrease in the performance domain (p = 0.01) with a lower number indicative of better perceived performance. There was a significant reduction in the mean number of pages received by admitting hospitalists over their 9-h shifts (81.3 + 17.3 vs 52.4 + 7.3; p < 0.01). CONCLUSION The implementation of the Triage Nurse role was associated with a significant decrease in the perceived workload of admitting hospitalists. Our findings are important because workload and interruptions can contribute to errors and burnout. Future studies should test interventions to improve hospitalist workload and evaluate their effect on patient outcomes and physician wellness.
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Affiliation(s)
- Gopi J Astik
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nita Kulkarni
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rachel M Cyrus
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Biostatistics Collaboration Center, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ward Capacity Strain: A Novel Predictor of Delays in Intensive Care Unit Survivor Throughput. Ann Am Thorac Soc 2020; 16:387-390. [PMID: 30407847 DOI: 10.1513/annalsats.201809-621rl] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Lu C, Hu Y, Fu Q, Governor S, Wang L, Li C, Deng L, Xie J. Physician Mental Workload Scale in China: Development and Psychometric Evaluation. BMJ Open 2019; 9:e030137. [PMID: 31619422 PMCID: PMC6797283 DOI: 10.1136/bmjopen-2019-030137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 09/06/2019] [Accepted: 09/26/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The purpose of our study is to develop a mental workload scale for physicians in China and assess the scale's reliability and validity. DESIGN The instrument was developed over three phases involving 396 physicians from different tiers of comprehensive public hospitals in China. In the first phase, an initial item pool was developed through a systematic literature review. The second phase consisted of two rounds of Delphi expert consultations and a pilot survey. The third phase tested the reliability and validity of the instrument. SETTING Public hospitals in China. PARTICIPANTS A total of 396 physicians from different tiers of comprehensive public hospitals in China participated in this study in 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Cronbach's α, content validity index, item-total score correlation coefficient, dimension-total score correlation coefficient and indices of confirmatory factor analysis. RESULTS Six dimensions (mental demands, physical demands, temporal demands, perceived risk, frustration level and performance) and 12 items were identified in the instrument. For reliability, Cronbach's α for the whole scale was 0.81. For validity, the corrected item-content validity index of each item ranged from 0.85 to 1, item-total score correlation coefficients ranged from 0.31 to 0.75, and the correlation coefficients between the dimensions and total score ranged from 0.37 to 0.72. The results of the confirmatory factor analysis showed that the goodness-of-fit indices of the scale were satisfactory. CONCLUSION The instrument showed good reliability and validity, and it is useful for diagnosing the mental workload of physicians.
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Affiliation(s)
- Chuntao Lu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Jingmen NO.2 People's Hospital, Jingmen, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Fu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Samuel Governor
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Liuming Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Li
- Jingmen NO.2 People's Hospital, Jingmen, China
| | - Lu Deng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinzhu Xie
- The Third People's Hospital of Hubei Province, Wuhan, China
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Sharma U. Ideal Hospitalist Workload in a 12-Hour Shift. Am J Med Qual 2019; 34:98. [DOI: 10.1177/1062860618778347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wingo MT, Halvorsen AJ, Beckman TJ, Johnson MG, Reed DA. Associations between attending physician workload, teaching effectiveness, and patient safety. J Hosp Med 2016; 11:169-73. [PMID: 26741703 DOI: 10.1002/jhm.2540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/30/2015] [Accepted: 11/08/2015] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Majken T Wingo
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew J Halvorsen
- Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas J Beckman
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew G Johnson
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Darcy A Reed
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Abstract
PURPOSE OF REVIEW Growth in critical care services has led to a dramatic increase in the need for ICU physicians. The supply of intensivists is not easily increased and there is pressure to solve this problem by increasing the number of patients per intensivist. There is a scarcity of published data addressing this issue, and until recently, there were no guidelines on appropriate ratios of intensivists to patients. RECENT FINDINGS In 2013, the Society of Critical Care Medicine formed a task force to address this issue and published written guidelines to aid hospitals in determining their intensivist staffing. This study reviews the published data which can aid these decisions and summarize the SCCM Taskforce's recommendations. SUMMARY The complex nature of critical care patients and ICUs make it difficult to provide one specific maximum intensivist-to-patient ratio, but common-sense rules can be applied. These recommendations are predicated on the principles that staffing can impact patient care as well as staff well-being and workforce stability. Also, that worsening patient outcomes, teaching, and workforce issues can be markers of inappropriate staffing. Finally, if the predicted daily workload of an intensivist exceeds the time of a work shift, then adjustments need to be made.
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