Associations between hospitalist physician workload, length of stay, and return to the hospital

Djulbegovic, Mia; Chen, Kevin; Cohen, Andrew; Heacock, Daniel; Canavan, Maureen; Cushing, William; Agarwal, Ritu; Simonov, Michael; Chaudhry, Sarwat I.

doi:10.1002/jhm.12847

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…Elliot et al 3 reported that, based on the census and RVUs, the increase in hospitalists’ workload is associated with the increase in length of stay and hospital costs. Djulbegovic et al 9 affirmed that the length of stay was prolonged by 0.05 days when comparing the 75th workload percentile with the 25th workload percentile (95% CI, 0.02–0.08; P < 0.001). Moreover, Guan et al 10 found that higher rates of inappropriate prescribing were associated with heavier workloads ( β = 0.132, SE = 0.016; P < 0.001), whereas Wingo et al 11 reported that an increase in the attending physician’s workload was associated with an increase in patient safety indicators such as transfers to the intensive care unit, calls to the rapid response team, and deaths (OR, 1.81; 95% CI, 1.21–2.71; P = 0.0001).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Daytime Surgical Hospitalists on Reducing Night Shift Physicians’ Workload

Jung

Lee

2023

J Patient Saf

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Background: The shortage of doctors at night makes it difficult to execute complex tasks and deliver accurate decisions. Therefore, reducing the night shift physician's workload is essential for patient safety. This study aimed to observe the effect of daytime surgical hospitalists on the reduction in night shift physicians' workload by analyzing the volume of electronic orders generated at night for postoperative patients.Methods: A total of 9328 hospitalized patients who underwent colorectal or gastrointestinal surgery for more than 120 minutes were reviewed retrospectively. This study reviewed the nighttime volume difference of electronic orders between patients cared for by a daytime surgical hospitalist and patients cared for by a resident. Multiple logistic regression analysis was performed to analyze the risk factors of nighttime orders during hospitalization (dichotomous end point). Negative binomial regression analysis was also performed to analyze the volume of electronic orders as countable data, and the incident rate ratio was estimated (count end point). Results:The risk of the occurrence of nighttime electronic order for patients treated by a surgical hospitalist was lower than that of patients cared for by a resident (adjusted odds ratio, 0.616; 95% confidence interval, 0.558-0.682; P < 0.001). In the negative binomial regression analysis, the total volume of electronic orders at night was lower in patients cared for by a surgical hospitalist than in patients cared for by a resident (adjusted incident rate ratio, 0.653; 95% confidence interval, 0.623-0.685; P < 0.001). Conclusions:The introduction of daytime surgical hospitalists is associated with the lower workload of night shift physicians.

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Section: Discussionmentioning

confidence: 99%

The Effect of Daytime Surgical Hospitalists on Reducing Night Shift Physicians’ Workload

Jung

Lee

2023

J Patient Saf

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“…1 Measuring the ADC at midnight may underestimate the work required of clinical teams during times of peak census, which also represents peak admission and discharge times. Understaffing during peak hours may contribute to decreased throughput 9 and increased levels of physician burnout. 10 If census is being measured at just one time of day, our data suggest that hospitals should consider doing so at the time of peak census, which at our institution occurred between 7 a.m. and 11 a.m.…”

Section: Discharges Occurred Almost Exclusively During Daytime Hoursmentioning

confidence: 99%

Finding the time: Hourly variation in average daily census on a hospital medicine service

Pierce,

Judson,

Mourad

2023

Journal of Hospital Medicine

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Monitoring the average daily census (ADC) is crucial for managing patient flow and allocating resources. This study analyzed hourly fluctuations in the ADC on a hospital medicine service at an academic medical center. Data from 8342 encounters and 6178 unique patients were collected over a year. The ADC peaked at 11 a.m. (164.1 patients/day) and was lowest at 7 p.m. (155.0 patients/day), accounting for a variation of up to 9.1 patients (5.5% of peak census) depending on the time of day the measurement was taken. Understanding how ADC changes throughout the day will help hospital medicine programs to partner with administrators to optimize resource allocation and staffing. Measuring ADC at midnight, as traditionally done, may underestimate workload and therefore contribute to staffing shortages and physician burnout. Hospitals should consider measuring ADC at its peak, between 7 a.m. and 11 a.m., to ensure adequate staffing and high‐quality patient care.

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“…Full-capacity protocol is a host of actions that can include transferring ED patients to the "next-appropriate" bed (e.g., inpatient hallways, dialysis rooms), 37,38 and is associated with lower quality, [39][40][41] perhaps through the influence on workload. Higher workload for inpatient physicians and nurses is associated with increased length of stay, 42,43 higher readmissions, 44,45 and higher mortality and morbidity. 43,[46][47][48] This may occur because higher workload may challenge efficiency and stretch physician and staff capacity and time with each patient, leading to a longer length of stay and higher risk of mortality.…”

Section: Introductionmentioning

confidence: 99%

Association of emergency department crowding with inpatient outcomes

Hsuan

Segel

Hsia

et al. 2022

Health Services Research

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Associations between hospitalist physician workload, length of stay, and return to the hospital

Cited by 5 publications

References 28 publications

The Effect of Daytime Surgical Hospitalists on Reducing Night Shift Physicians’ Workload

The Effect of Daytime Surgical Hospitalists on Reducing Night Shift Physicians’ Workload

Finding the time: Hourly variation in average daily census on a hospital medicine service

Association of emergency department crowding with inpatient outcomes

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