We examined the relationship between workload and patient safety via a survey of an online community of Hospitalists. This analysis examines the predictors of providers reporting an “unsafe” workload, identifying potential targets for quality improvement.
We electronically surveyed 890 selfidentified Hospitalists enrolled in QuantiaMD.com, an online physician community which provides continuing medical education and a national discussion forum. The survey queried physician and practice characteristics, workload, frequency of an unsafe census, and what a “safe” workload would be in his/her setting. We specifically excluded night, weekend, and holiday shifts in the question stems. “Safe” was defined as “with minimal potential for error or harm.” We categorized physicians into two groups: those reporting unsafe patient workload less than once a month versus at least monthly. We performed logistic regression to determine which physician, hospital and team characteristics were associated with increased report of an unsafe census.
Of the 890 physicians contacted, 506 (57%) responded. Physicians had an average age of 38.3 years (SD: [pm]8.4) and were in practice for a median of 6 years [IQR: 3, 10]. Physicians practiced primarily in urban (46.4%) or suburban (42.5%) settings and as part of a community hospital (54%) or academic teaching hospital (27.9%). Forty percent of physicians (n = 202) reported that their typical inpatient census exceeded safe levels at least monthly. Higher frequency of reporting an unsafe census was associated with higher percentages of clinical (P = 0.004) and inpatient responsibilities (P < 0.001) and more time seeing patients without midlevel or housestaff assistance (P = 0.03). Lower frequency of reporting an unsafe census was associated with more years in practice (P = 0.02), greater percentage of personal time (P = 0.02), higher percentage assistance by housestaff (P = 0.002), and the presence of any system for census control (patient caps, staffing augmentation plans, fixed bed capacity; P = 0.007). Fixed census caps decreased the odds of reporting an unsafe census by 34% and was the only statistically significant workload control mechanism (OR: 0.66; 95% CI: 0.43, 0.99; P = 0.04). There was no association between unsafe census and physician age (P = 0.42), practice area (P = 0.63), organization type (P = 0.98), or compensation (salary [P = 0.23], bonus [P = 0.61], or total [P = 0.54]).
Forty percent of Hospitalists reported an unsafe workload at least monthly. Less experience, less housestaff or midlevel assistance, higher percentages of inpatient and clinical responsibilities and no systems for census control were strongly associated with reports of unsafe workload. Providing hospitalists with greater amounts of assistance and systems to deal with census fluctuations may improve the safety and quality of patient care regardless of organization type or location.
To cite this abstract:Driscoll B, Brotman D, Michtalik H, Paskavitz M, Pronovost P. Identifying Predictors of a Safe Attending Physician Workload: Results from a Survey of an Online Community of Hospitalists. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97586. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/identifying-predictors-of-a-safe-attending-physician-workload-results-from-a-survey-of-an-online-community-of-hospitalists/. Accessed September 18, 2019.