Hospitalists flag patient overload threat to safety

Two-fifths of US hospitalists say their average patient load exceeds safe levels at least monthly, according to a nationwide survey.

Just under a quarter also believe that the excess workload directly impairs patient care, by preventing full discussion of treatment options and worsening patient satisfaction.

And over a fifth report ordering potentially unnecessary investigations because they do not have time to properly evaluate individual patients themselves.

"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," explained lead author Henry Mitchalik in a press statement.

Mitchalik and colleagues, from Johns Hopkins Hospital in Baltimore, Maryland, electronically surveyed 890 self-identified hospitalists from across the USA enrolled on the physician community. In all, 506 responded to the survey, among whom the average age was 38 years and the median time in practice was 6 years.

As reported in JAMA Internal Medicine, 40% of hospitalists said their typical inpatient census exceeded safe levels at least monthly, with 36% of them reporting it happened at least once weekly.

In addition, 25% reported that the excess workload frequently meant they were unable to discuss treatment options fully or answer questions of a patient or family member, while 22% said it often caused delays with patient admissions and/or discharges, and 19% that it often worsened patient satisfaction.

Furthermore, over 20% reported that their workload likely contributed to patient transfers to higher levels of care, morbidity, and even mortality.

"As perceived by physicians, workload issues have the significant potential to do harm and decrease quality," Mitchalik said. "It is the elephant in the room that cannot be ignored. We have to find that balance between safety, quality, and efficiency."

"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," the authors conclude.

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