More than 25% of hospitalists say their average patient load exceeds safe levels multiple times per month, according to a study published in JAMA Internal Medicine. The study found 20% of the hospitalists reported their workload "likely contributed to patient transfers, morbidity, or even mortality."
The study, conducted by researchers at Johns Hopkins University, comes in the vanguard of significant changes in healthcare, including an anticipated influx of new patients generated by the Affordable Care Act over the next few years; restrictions on residents' shift hours; and retirement of a large segment of the country's physicians.
"As perceived by physicians, workload issues have the significant potential to do harm and decrease quality," study leader Henry J. Michtalik, M.D.,an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, said in a release announcing the study's publication. "It is the elephant in the room that cannot be ignored. We have to find that balance between safety, quality and efficiency."
Michtalik and his colleagues electronically surveyed 890 self-identified hospitalists enrolled in an online physician community, QuantiaMD.com. Of the 506 who responded over the course of four weeks in November 2010, the average age was 38 years and more than half worked in community hospitals. Among other questions, physicians were asked to report what they felt was a safe number of patients to see in a typical shift. Most physicians reported that they could safely see 15 patients in a shift if they could focus 100 percent on clinical matters. When the average actual workload was compared to the perceived safe workload, 40% of physicians exceeded their own reported safe level.
22% of the respondents reported ordering costly and potentially unnecessary tests, procedures, or consults because they didn’t have time to properly assess patients assigned to their care. "If a hospitalist is short on time and a patient is having chest pains, for example, the doctor may be more likely to order additional tests, prescribe aspirin and call a cardiologist, all because there isn’t adequate time to immediately and fully evaluate the patient," Michtalik said.