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Survey Finds Excessive Physician Workload Affects Patient Safety

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We’ve heard about the long work hours common in the healthcare industry. Doctors, nurses, and other health care professionals frequently work shifts of 12 hours or more. How do workloads affect patient safety?

A new study out of Johns Hopkins University sheds some light on the question.

Study Results Show Effects of Heavy Workloads

For this study, researchers examined survey results from 506 hospitalists—specialists that coordinate patient care and medications. The survey asked questions about various hospital issues, including the impact of heavy workloads on patient care.

Results showed the following:

  • 40 percent said the typically inpatient workload exceeded safe levels at least once a month.
  • 36 percent said inpatient workload exceeded safe levels at least once a week.
  • 22 percent said they had delayed admitting or discharging a patient until a subsequent shift because of excessive workloads.
  • 22 percent said they ordered potentially unnecessary tests, procedures, or consultations as a result of excessive workloads.
  • 12 percent said their overall quality of care was negatively affected by excessive workloads.
  • 10 percent said that because of excessive workloads, they failed to note or act on critical lab results.
  • 14 percent reported their heavy workload increased readmission rates.
  • 19 percent said workload reduced patient satisfaction.
  • 5 percent reported that the heavy workload may have caused at least one death over the year.

Lead study author Henry Michtalik stated, “As perceived by physicians, workload issues have the significant potential to do harm and decrease quality.”

The authors added, “Excessively increasing the workload may lead to suboptimal care and less direct patient care time, which may paradoxically increase, rather than decrease costs.”

Study Author Notes Effects on Patient Evaluation

In a published conversation with Michtalik, JAMA revealed more about the study results. Michtalik stated, for instance, that one of the biggest impacts of excessive workload was on discussions with patients. One in four hospitalists reported not being able to fully discuss treatment options or answer patient questions because they lacked adequate time. One in four doctors also reported they were ordering unnecessary tests because they didn’t have time to evaluate patients to better determine which tests would be most useful.

“We may be being penny-wise by increasing patients per clinicians,” he said, “but pound-costly by increasing the costs of downstream care, such as tests and consults.”

Patients who have been injured by medical negligence may want to look into the hospital’s guidelines and records for physician workload to see if overwork may have been a factor in the incident.

1 Comment

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  1. William Hyman says:
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    Isn’t this exactly what one would think would be the case? It has long been recognized that fatigue is detrimental to performance. There are many occupations that have mandated work hour limits in the interest of protecting public safety. How many people want their pilot to have been awake and on the job for, say, 20 hours? Do we really want to pretend that clinicians are so unique that fatigue doesn’t effect them? Or perhaps that they don’t get fatigued?

    A related issue is night shift workers. What did they do all day before now coming in to work? Did they really sleep the equivalent amount of day shift workers?