Heavy Workloads for Hospitalists Correlate to Longer Patient Stays
When workloads increase for hospitalists—the physicians who care exclusively for hospitalized patients—length of stay (LOS) and costs increase, too, according to a study published by JAMA Internal Medicine.
Researchers at Christiana Care Health System, a large academic community hospital system in Delaware, analyzed 20,241 inpatient admissions for 13,916 patients over a three-year period. Hospitalists had an average of 15.5 patient encounters per day, and LOS increased from 5.5 to 7.5 days as workloads increased at hospitals with occupancies under 75 percent.
Each additional patient seen by hospitalists increased costs by $262, although increasing workload did not affect outcomes such as mortality, 30-day readmission rates, and patient satisfaction.
“Our results suggest that incentives aimed at increasing workload may lead to inefficient and costly care,” the researchers wrote. “In systems that incentivize physicians based on productivity, consideration should be given to including measures of efficiency and quality.”
In related commentary, Robert M. Wachter, MD, of the University of California, San Francisco, observed that the study is “one of the first to address the question of the optimal workload for any physician. This question has been studied in nursing and, to a lesser extent, among residents, and such studies have helped shape policy.”