January 29, 2013
Hospital-Based Physicians Report Increased, Unsafe Patient Workloads
Lawrence LeBlond for redOrbit.com - Your Universe Online
Hospital-based general practitioners are reporting an increased workload from patients´ primary care physicians, and they note that this shift is exceeding safe levels on multiple occasions each month.
A study, conducted by Johns Hopkins Medicine, and published in JAMA Internal Medicine, highlights this issue by finding one in five of hospital-based physicians, often referred to as hospitalists, report that this increased workload puts patients at risk for serious complications, or even death.
The study comes as healthcare systems anticipate a flood of new patients generated by the adoption of the Affordable Care Act, which was signed into law by President Barack Obama on March 23, 2010.
As resident-physicians´ duty hours decline and some 30 percent either retire or leave the medical field over the next ten years, any increased need in patient care will be met by already-stressed staffing problems.
"As perceived by physicians, workload issues have the significant potential to do harm and decrease quality," said study leader Henry J. Michtalik, M.D., M.P.H., M.H.S., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine. "It is the elephant in the room that cannot be ignored. We have to find that balance between safety, quality and efficiency."
The study comprised a survey of 890 hospitalists across the country, of which 506 responded. Of the respondents, 22 percent reported ordering costly and potentially unnecessary tests, procedures or consultations because they didn´t have the time to assess patients assigned to their care.
"If a hospitalist is short on time and a patient is having chest pains, for example, the doctor may be more likely to order additional tests, prescribe aspirin and call a cardiologist – all because there isn't adequate time to immediately and fully evaluate the patient," Michtalik said in a statement.
Michtalik´s study focused on hospitalists enrolled in the online physician community QuantiaMD.com. Of those who responded to the survey, the average age was 38 and more than half worked in a community hospital. The survey took respondents over a four-week course in November 2010.
Physicians in the survey were also asked what they felt was a safe number of patients to see during a typical shift. Most said they could see 15 patients during their shift as long as they could focus 100 percent on clinical matters. When the average actual workload was compared to the perceived safe workload, 40 percent of hospitalists exceeded their own safe level.
Michtalik said that hospitalists at Johns Hopkins´ hospitals generally fall below that number, while those in community hospitals often see more than 15 patients per shift.
"Hospitals need to evaluate workloads of attending physicians, create standards for safe levels of work and develop mechanisms to maintain workload at safe levels," he concluded.