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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...

A Nationwide Program for Improving Quality & Safety

Throughout the United States, efforts are being made to improve the overall quality of healthcare, reduce racial and ethnic disparities, and provide models for national reform. One such effort is the Aligning Forces for Quality (AF4Q) program. Supported by the Robert Wood Johnson Foundation, the AF4Q program brought together hospitals in 16 geographically, demographically, and economically diverse communities that together cover 12.5% of the U.S. population. Ranging from major metropolitan areas to a Northern California county of 260,000 people, each community partaking in the program makes concerted efforts to address public reporting of quality, patient engagement in care decisions, and physician payment. Each of the 16 communities participated in the AF4Q Hospital Quality Network (HQN). Teams at participating hospitals came together for learning sessions via webinars to identify where problems existed and how they had been addressed. According to Robert Graham, MD, two of the areas focused on for the HQN program were reducing readmissions and improving language services. Catherine A. West, MS, RN, adds that process and outcomes measures were collected and reported monthly to the AF4Q National Program Office at George Washington University. Reducing Hospital Readmissions “The AF4Q program focused strongly on readmissions among patients with congestive heart failure because of their high risk for being readmitted,” says Dr. Graham. “Across the board, participating hospitals achieved the most success with early identification of these patients and participation in transitions programs [Table 1]. These programs allow for patients to know—as they’re discharged—exactly what they need to do, what has changed, why it’s changed, and how to link with physicians in the community. The key is to ensure that...

Delayed ED Care for the Morbidly Obese

The disposition home for morbidly obese patients appears to take significantly longer than that of people who are normal weight or mildly obese, according to a comparison of ED medical records for the two patient groups. Those with BMIs greater than 40 kg/m2 had an average length of stay of 388 minutes, compared with 287 minutes for those with a BMI less than 35 kg/m2. When compared with others, morbidly obese patients were also significantly more likely to undergo CT scans. Abstract: American Journal of Emergency Medicine, June...

Delayed ED Care for the Morbidly Obese

An analysis of ED medical records suggests that morbidly obese patients take significantly longer to disposition home when compared with patients of normal weight. Patients with a BMI of less than 35 kg/m2 had an average length of stay of 287 minutes, compared with an average of 388 minutes for those with a BMI higher than 40 kg/m2. When compared with patients of normal weight or with mild obesity, the authors also found that those with a BMIs higher than 40 kg/m2 were significantly less likely to undergo CT scans. Abstract: American Journal of Emergency Medicine, June...
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