Impact of Workload on Patient Safety and Quality of Care: A Survey of an Online Community of Hospitalists

1Johns Hopkins University School of Medicine, Baltimore, MD
2Quantia Communications, Waltham, MA

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 81


Studies of the impact of provider workload on patient safety and quality of care have primarily focused on nurses and resident physicians, but not hospitalists. We examined the relationship between workload and patient safety and quality via a survey of an online community of hospitalists.


We electronically surveyed 890 self‐identified hospitalists enrolled in, an online physician community that provides continuing medical education and a national discussion forum. Participants received a secure e‐mail link to the online survey and were awarded $10 at completion. The survey queried physician and practice characteristics, workload, frequency of an unsafe census, and what a “safe” workload would be in his/her setting. “Safe” was defined as “with minimal potential for error or harm.” Physicians also rated the impact of average census on process and outcome measures using a Likert scale ranging from 1 = never/definitely not to 5 = very often/definitely.


Of the 890 physicians contacted, 506 (57%) responded. Five (1%) were excluded for not completing the survey. Physicians had an average age of 38.3 ± 8.4 years and were in practice for a median of 6 years (IQR, 3, 10 years). The majority identified their primary practice area as adult (77.8%), pediatric (1.2%), or combined medical/pediatrics (1.6%) hospital medicine. Physicians practiced in urban (46.4%), suburban (42.5%), and rural (11.1%) settings and primarily as part of a community hospital (54%), academic teaching hospital (27.9%), or private group (11.7%). Forty percent of physicians reported that their typical inpatient census exceeded safe levels at least monthly and 36.1% of these reported a frequency greater than once per week. When the average actual workload was compared to the perceived safe workload, 40.1% of physicians exceeded their own reported safe level. Physicians reported that their patient load often (≥4/5) led to incomplete patient/family discussions (24.6%), ordering potentially unnecessary tests or procedures (22%), delaying admitting or discharging patients until the next shift or day (21.5%), cross‐covering (20.3%) or caring (16.5%) for too many patients, worsened patient satisfaction (19.3%), poorer hand‐offs (17.9%), increased 30‐day readmission (14%), worsened overall quality of care (12.4%), failure to promptly act on critical findings (9.8%), and treatment errors (6.5%). With respect to adverse events, physicians reported that workload has likely (≥4/5) caused transfers to higher levels of care (9.8%), morbidity/complications (6.9%), mortality (0.6%), and incident reports (5.7%).


Forty percent of hospitalists reported an unsafe workload at least monthly. More than 20% of hospitalists reported the workload has often caused incomplete patient discussions, unnecessary tests and procedures, admission/discharge delays, and excessive cross‐coverage. Hospitalist workload may be adversely affecting patient safety and quality of care and should be further explored.


H. Michtalik ‐ none; P. Pronovost ‐ none; B. Driscoll ‐ Quantia Communications, managing editor; M. Paskavitz ‐ Quantia Communications, editor‐in‐chief; D. Brotman ‐ Quantia Communications, consultant

To cite this abstract:

Michtalik H, Pronovost P, Driscoll B, Paskavitz M, Brotman D. Impact of Workload on Patient Safety and Quality of Care: A Survey of an Online Community of Hospitalists. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 81. Journal of Hospital Medicine. 2011; 6 (suppl 2). Accessed March 28, 2020.

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