Hospitalist work loads could compromise patient safety

January 12th, 2015

A new survey of hospital docs shows that many end up with bigger patient loads than they can handle – patient loads that can compromise patients’ safety.

The Johns Hopkins University School of Medicine study, published in JAMA Internal Medicine, included responses from 506 hospital physicians. Forty percent said that they take difficult-to-handle patient loads at least once per month, with 36% reporting that this happens once a week. Forty percent exceed their own standards of safe patient loads (generally, 15 patients per shift with 100% clinical effort).

Other findings include:

--25% said they were unable to fully discuss treatment options or answer questions due to patient load

--22% ordered potentially unnecessary tests due to not having enough time to fully assess the patient

--22% delayed discharge or admitting until the next shift

--18% said patient load adversely affected quality of handoffs

--7% said it was likely that patients suffered morbidity or complications due to workload

"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," said lead author Dr. Henry Michtalik.

So what could the causes be for physicians to take on patient loads that even they admit can be dangerously large? In the study, Michtalik suggests that monetary concerns could be a factor, with physicians taking on more patients as reimbursements decrease. Hospitals must evaluate patient loads and create safety standards, researchers said. In their next study, Michtalik and colleagues will look into factors that contribute to safe patient loads.