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As Hospitalist Patient Loads Rise, So Do Hospital Costs

Cheryl Clark, for HealthLeaders Media, April 11, 2014

A study stops short of identifying the optimal hospitalist-to-patient ratio, but "workload does have implications for efficiency of care," says the study's lead author.

The maximum number of patients a hospitalist can efficiently manage is approximately15, research suggests.

In an efficiency and safety study conducted at a Delaware healthcare system, patients assigned to hospitalists who were responsible for more than 15 inpatients per day were linked to longer patient stays and higher costs than patients of hospitals with lighter patient loads.

The study findings are published in a recent JAMA Internal Medicine report examining the potential impact of increasing patient loads on hospitalists. Patient load is measured by relative value units or RVUs, a unit of measure Medicare uses to determine how doctors should be paid for patient care.

"We did this study because the question about how many patient contacts is the right number has been hotly debated in hospital medicine for years," says Daniel Elliott, MD, principal author of the report and co-director of ambulatory medicine research at the two-hospital, 1,100-bed Christiana Care Health System in Wilmington, DE.

Though regional recommendations range between having 10 and 15 patients per hospitalist, depending on typical patient mix and acuity, 40% of hospitalists in a recent survey said their workloads spiked beyond safe levels at least monthly.

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