• J Hosp Med · Jun 2022

    Observational Study

    Associations between hospitalist physician workload, length of stay, and return to the hospital.

    • Mia Djulbegovic, Kevin Chen, Andrew B Cohen, Daniel Heacock, Maureen Canavan, William Cushing, Ritu Agarwal, Michael Simonov, and Sarwat I Chaudhry.
    • Department of Internal Medicine, National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.
    • J Hosp Med. 2022 Jun 1; 17 (6): 445455445-455.

    BackgroundHospitalist physicians' workload-the total number of patients they care for daily-is rising in the U.S. Hospitalists report that increased workload negatively affects patients care.ObjectiveMeasure the associations between hospitalist physicians' workload and clinical outcomes.Design, Settings, And ParticipantsObservational study, using electronic health record (EHR) data, of adults hospitalized on the hospitalist service at Yale-New Haven Hospital from 2015-2018.Main Outcome And MeasuresWe defined hospitalists' workload as the number of patients they cared for on the first full hospital day of a given patient's encounter. We used multilevel Poisson and logistic regression to examine associations between workload and length of stay (LOS), return to the Emergency Department (ED), and readmission. We adjusted for sociodemographic factors, patient complexity and severity of illness, and weekend admission (for LOS) or discharge (for ED visits or readmission).ResultsWe analyzed 38,141 hospitalizations. Median patient age was 64 years (IQR 51-78 years), 53% were female, and 34% were nonwhite. Mean workload was 15 patients (SD 3 patients; range 10-34 patients). LOS was prolonged by 0.05 days (95% CI 0.02, 0.08; p(0.001) when comparing the 75th workload percentile (16 patients) to the 25th workload percentile (13 patients). There were no associations between workload and ED visits or readmission within 7 and 30 days.ConclusionsThere was a statistically significant but modest relationship between workload and LOS; workload was not associated with ED visits or readmissions.Given clinical reports of the deleterious effects of increased hospitalist workload, there is a need for prospective research assessing a range of outcomes, beyond those measurable in contemporary EHR data.© 2022 Society of Hospital Medicine.

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