Patient Care May Suffer from Overworked Physicians

A new study reveals that many attending physicians feel overburdened to the point where it has a negative impact on patient assessments, satisfaction, and possibly safety outcomes.

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) conducted a survey involving 506 self-identified hospitalists enrolled in an online physician community. The survey included questions on physician, hospital, and team characteristics; workload; frequency of unsafe census; and estimates of what a safe workload would be, represented by the number of patients that could be seen in a shift with minimal risk of error or harm. Study participants had a mean age of 38.3 and had practiced medicine for a median 6 years in mostly urban or suburban settings.

The results showed that a quarter of respondents were unable to discuss treatment options or answer patient questions fully, while 22% said they had to delay admitting or discharging patients until a subsequent shift. One in five cross-covered more patients than was safe, while 22% reported ordering potentially unnecessary tests or procedures because they did not have the time to do an in-person assessment. Other findings included 18% of respondents who said they had seen too many patients to the point where it adversely affected the quality of their hand-offs; 10% failed to note or act on critical lab results due to patient volume, and 12% said their workload worsened overall quality of care. The study was published as an online research letter on January 28, 2013, in JAMA Internal Medicine.

“Up to 98,000 patients die each year in the hospital as a result of preventable medical errors,” said lead author Henry Michtalik, MD, MPH, MHS, and colleagues. “For resident physicians, workload so heavy as to result in physician fatigue is associated with increased medical errors and has led to the implementation of work-hour restrictions.”

“Given the large number of patients cared for by hospitalists, the frequency with which workload exceeds safe levels, and the perceived impact of workload on patient outcomes, hospital administrators, researchers, and policymakers should focus attention on attending physician workload,” they concluded.

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