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The Impact of Hospitalist Workload on Patient Care

The Impact of Hospitalist Workload on Patient Care

The workload for hospitalists has increased significantly, thanks in part to increased residency work-hour restrictions, greater access for patients to healthcare, and a general focus among hospitals to improve patient volume and throughput. Further complicating matters is that hospitalists are adept at functioning in different hospital environments and capacities, which has increased their use and workload. To assess the impact of workload on patient safety and quality measures, my colleagues and I conducted a national survey of hospitalists that was published in JAMA Internal Medicine. Hospitalists Reporting Unsafe Workloads According to our results, about 40% of hospitalists reported that their workload exceeded safe levels (more than 15 patients per shift) at least monthly, and 36% said it happened more than once a week. Approximately one-quarter of respondents reported that excessive workload delayed the admission or discharge of patients until the next shift or hospital day, which in turn impacted length of stay and workloads among ED providers. In addition, 25% of respondents reported that they failed to fully discuss treatment options or to answer questions from patients and family members, and 19% said patient satisfaction soured due to unsafe workloads. Furthermore, 18% reported that it adversely affected patient handoffs. More than 20% of physicians reported that their average workload likely contributed to patient transfers, morbidity, or even mortality. High Hospital Admissions Taking a Toll High levels of admissions and unexpected health changes among admitted patients can dramatically affect the workload of hospitalists and ED physicians. In turn, these changes can increase lengths of stay and clog processes of care in the ED. To overcome these issues, a mutual understanding...

Hospitalists & the Intensivist Shortage

The growing intensivist shortage is challenging hospitals’ ability to care for critically ill patients. Despite numerous recommendations that intensivists manage critically ill adults, the majority of American hospitals cannot meet this standard. As a consequence, hospitalists have become de facto intensivists in many hospitals, with 75% reporting that they practice in the ICU. While legitimate concerns have been raised whether hospitalists are uniformly qualified to practice in the ICU, the issue has become moot at many hospitals where intensivists are either in short supply or entirely absent. Efforts are needed to ensure that hospitalists manage critically ill patients safely, effectively, and seamlessly. In the Journal of Hospital Medicine and Critical Care Medicine, the Society of Hospital Medicine and the Society of Critical Care Medicine co-published a position paper on training the hospitalist workforce to address the intensivist shortage. In this paper, we discussed the potential value of hospitalists in the ICU and the importance of enhancing hospitalists’ skills to provide critical care services. Adding Value & Enhancing Skills of Hospitalists Hospital medicine and critical care medicine share similar structures, competencies, and values, positioning hospitalists as a logical solution to the intensivist shortage. Many of the competencies needed for practicing critical care medicine are encompassed in internal medicine training as well as in core competencies in hospital medicine. The ideology and mechanics of high-performing hospitalist and intensivist programs are similar, yet despite these commonalities, hospitalists remain largely untapped as a potential source of new intensivists. Exploring Alternative Critical Care Models With no solution to the intensivist shortage in sight, alternative critical care delivery models are needed. We proposed a 1-year...
Hospitalist-Provided Care May Inflate Medicare Bills by $1.1 Billion

Hospitalist-Provided Care May Inflate Medicare Bills by $1.1 Billion

The hospitalist specialty is one of the fastest growing specialties in the country, largely because of the perceived association with hospital length of stay and costs. However, until recently, no national study had examined the effects of hospitalist-provided care on hospital costs, medical utilization after discharge, or costs after discharge. Two researchers from the University of Texas Medical Branch set out to determine the effect of hospitalists on hospital costs. Published in the August 2, 2011 Annals of Internal Medicine, the study concluded that the decreased length of stay and hospital costs associated with care provided by hospitalists are offset by increased medical utilization and costs after discharge. The study authors—Yon-Fang Kuo, PhD, and James S. Goodwin, MD—performed a population-based national cohort study using a 5% sample of Medicare parts A and B enrollees who had primary care physicians and were cared for by either that provider or a hospitalist during medical hospitalizations between 2001 and 2006. For about 58,000 patients involved in the study, measurements were taken for length of stay, hospital charges, discharge location, physician visits, ED visits, rehospitalization, and Medicare spending up to 30 days after discharge. Following a propensity score analysis, Drs. Kuo and Goodwin found that average hospital length of stay was 0.64 days fewer and hospital charges were $282 less for those who received care from hospitalists compared with those receiving care from their primary care physician. However, Medicare costs were $332 higher, on average, for those in the former group, adding up to what the researchers say is potentially an extra $1.1 billion for all patients with Medicare. View Hospitalist Study Abstract...
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