Guest Author - A. Maria Hester, M.D.
The hospitalist (hospital-based physician) movement is booming, and for good reason. It is very hard for physicians to see a full load of patients in the office, only to work even more hours seeing patients in the hospital after a long day. In addition, keeping up with the medical literature for both primary care and hospital-based medicine is challenging. As a result, many primary care physicians opt to, temporarily, turn their patients' care over to hospitalists to care for their patients when hospitalized.
There was an interesting Editorís Correspondence in the March 11, 2013 issue of JAMA regarding a recent article, namely, Impact of Attending Physician Workload on Patient Care: A Survey of Hospitalists.
While the results reflect a potential to do harm to those who trust doctors with their very lives, they also provide a tremendous opportunity to re-evaluate current systems and implement new initiatives that will both improve the quality of care doctors/hospitals provide patients and minimize unnecessary waste. Only when all parties involved really examine the results of this landmark report can we begin to seek solutions to the systematic inadequacies that cost people their lives and contribute to unsustainable escalation in health care costs.
A significant percentage (40%) of hospitalists surveyed reported unsafe workloads at least once per month. In addition, within the past year, hospitalistsí workloads were believed to result in the following negative outcomes:
An inability to fully discuss treatment options or adequately answer questions of patients and their family members. (25%)
Admissions or discharges were delayed until the next day or hospital shift. (22%)
Suboptimal patient hand-offs. (18%)
Failure to properly address critical lab results or radiology readings in a timely manner. (10%)
Errors in treatment or medication attributed to workload. (7%)
Worsened patient satisfaction. (19%)
Increased 30-day readmissions. (14%)
Potentially unnecessary diagnostic studies, procedures, and consultations were ordered due to lack of time to adequately assess the patient. (22%)
Decreased overall quality of care provided. (12%)
Morbidity, complications, or death. (12%)
The authors of this Correspondence noted that not only do hospitals need to routinely evaluate physiciansí workloads to maintain a safe environment for patients, society also needs to help reduce health care costs. Unfortunately, the main means by which health care costs are currently decreased are decreasing payments. When payments decrease, volume typically needs to increase to compensate in medicine, just as in other businesses. The result is that hospitalistsí workloads increase, which, as this article shows results in potentially suboptimal care for patients, which in turn, leads to undesirable outcomes, longer lengths of stay, and more readmissions, all of which are highly undesirable to patients, hospitalists, and administrators alike.
Meaningful dialogue to address these important implications must be prioritized and should involve direct communication between hospital administrators and the hospitalists who provide direct care to the patients.
However, by no means does this article imply that the hospitalist movement is in jeopardy. On the contrary, hospitalists are on site in the hospital, so they can be at the bedside within minutes should an emergency arise. They are highly trained in high-acuity illnesses which require patients to be hospitalized, and they arrange for important hospital records to be sent to patients' primary care physicians. The hospitalist movement is really a great movement, though like with every other profession, when the workload is very high, the results are less than optimal. This article points out that this is no less true in the medical profession and we need to seek ways by which we can improve processes.