4 in 10 Hospitalists Report Unsafe Patient Workloads

Cheryl Clark, January 30, 2013

Four in 10 hospitalists responding to a survey from Johns Hopkins University say their workloads exceeded safe levels at least once a month.

In a research letter published in JAMA Internal Medicine this week, authors Henry J. Michtalik, MD, Peter Pronovost, MD, and others also said that 36% of the 506 hospitalist respondents reported excessive workload assignments exceeding safe levels at least once per week.

"We weren't surprised that there is an issue with workload, and that providers believed it fluctuated to points that exceeded safe levels," Michtalik says. "But we were surprised at the frequency with which we were seeing this across all different kinds of institutions and practice settings, and with different providers."

Respondents said that time constraints prevented them from discussing treatment options, delayed patient admissions and discharges, and worsened patient experience scores. They acknowledged that their workload "likely contributed to patient transfers, morbidity, or even mortality."

Michtalik adds that failure of top hospital leadership to acknowledge excess workloads among hospitalists and attending physicians, who manage some of the sickest, most complex patients, could be "pound foolish."

"The typical response to reductions in payments and reimbursement (now impacting acute care revenue) is to increase patient flow and try to decrease length of stay, but what this would suggest is that while we're being penny wise in increasing flow and decreasing stay, we might be pound foolish by paradoxically increasing costs," Michtalik says.


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