Hospitalists see heavy workloads undermining care

Heavy workloads can contribute to unnecessary tests and procedures, poor transitions of care and increased complications and mortality, according to self-reported data from more than 500 hospitalists.

Researchers from Johns Hopkins University, Baltimore, collected survey responses from 506 hospitalists on topics such as how their excess workload affects patients' risk of adverse events or causes delays in discharging patients.

More than a quarter of hospitalists said their excess workloads prevented them from being able to answer patients' questions or adequately discuss treatment options, according to the survey results, published online in JAMA Internal Medicine. Eighteen percent said their workload affected the quality of patient handoffs, 10% said they were more likely to make a treatment or medication error when overworked, and 5% said their workload could mean a higher risk of mortality among their patients.

Patient satisfaction scores and 30-day readmission rates take a hit when physician workload exceeds safe levels, according to some respondents.

“As perceived by physicians, workload issues have the significant potential to do harm and decrease quality,” Dr. Henry Michtalik, a hospitalist at Johns Hopkins, and the study's lead author, said in a news release. “It is the elephant in the room that cannot be ignored. We have to find that balance between safety, quality and efficiency.”

The authors urged hospitals to regularly assess their physicians' workload and establish benchmarks for safe numbers of patient encounters per shift. Also, they cautioned that cost-cutting initiatives could have the opposite effect, particularly as harried and overworked physicians order expensive and potentially unnecessary tests and procedures.

“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.