Overworked Hospitalists Linked to Higher Costs, Longer Lengths of Stay


As hospitalist workloads increase, so do hospital costs and patients' lengths of stay (LOS), according to findings in a recent study.

Those results, says SHM President Burke T. Kealey, MD, SFHM, provide a good starting point to determine an ideal patient census for hospitalists.

"Pushing hospitalist workloads ever higher to meet the demands of patient-care needs or flawed payment models has costs associated with it," says Dr. Kealey, associate medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn. "The costs may be borne by the system or by patients, but there are costs."

For the study published in JAMA Internal Medicine, researchers analyzed data from 20,241 hospitalizations involving 13,916 patients seen by hospitalists at the Christiana Care Health System in Newark, Del., between February 2008 and January 2011.

For hospital occupancies less than 75%, they found that LOS increased from 5.5 to 7.5 days as workload increased. For occupancies of 75% to 85%, LOS increased to about 8 days with higher workloads. For occupancies greater than 85%, the LOS decreased slightly and then increased significantly with higher workloads, with this change occurring at about 15 patients or more per hospitalist.

Costs were also significantly associated with an increase in workload. As the study notes, benchmark recommendations for an individual hospitalist’s workload range from 10 to 15 patient encounters per day.

Dr. Kealey says the findings seem to support the conventional wisdom that hospitalists should ideally see no more than 15 patients a day. He notes, however, that deciding the optimal number of cases for a given practice depends on several factors, including duration of shift, the availability of physician extenders, and the addition of surgical or cardiology cases.

"We won't be able as a specialty to fully realize our potential until we understand and apply the learnings about workload into our practices to ensure hospitalist career sustainability, system health, and best patient care," Dr. Kealey says. "This paper really gets the discussion going."

For more from Dr. Kealey on hospitalist workloads, read his recent blog post on "The Hospital Leader." TH

Visit our website for more information about hospitalist workloads.

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