The Clinical Performance and Effectiveness of the Multiple-Attending-Physicians System Compared with the Single-Attending-Physician System in Inpatient Setting: A Mixed-Method Study

Abstract

BackgroundConsidering work styles especially of solo attending physicians, medical facilities have been required to effectively utilize sufficient human resources in many countries. Therefore, we compared cross-sectionally clinical performance of the single- and the multiple-attending physicians groups in inpatient care. Furthermore, we also qualitatively analyzed physicians’ working burden and quantitively assessed advantages / disadvantages of those attending physicians systems.MethodIn this cross-sectional study, we extract electronic health record of patients from a hospital in Japan from April 2017 to October 2018 to compare anonymous statistical data including average lengths of hospital stay and patient outcome between the single-attending and multiple-attending-physicians system. Then, we conducted a questionnaire survey for all physicians of single and multiple-attending physician systems, asking their physical and psychiatric working burden, and their reasons and comments on their working styles.ResultThe average length of hospital stay was significantly shorter in the multiple-attending physicians system than in the single-attending physicians system, while patients’ age, gender and diagnoses were similar. From the questionnaire survey, although physical burden in multiple-attending physicians system tended to be lower than that in single-attending physician system, no significant difference was found in all categories. Advantages of multiple-attending physicians system extracted from qualitative analysis are 1) Improvement of physicians ’ quality of life (QOL), 2) Lifelong-learning effect, and 3) Improving the quality of medical care, while disadvantages were 1) Risk of miscommunication, 2) Conflicting treatment policies among physicians, and 3) unfamiliar culture with multiple-attending physicians system.ConclusionMultiple-attending-physicians system in inpatient care may reduce physical burden on physicians, and not only improve QOL of physicians but lead to lifelong learning and improving the quality of medical care.