HOSPITAL OVERLOAD: Doctors overworked, patient care suffering

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 © 4774344sean According to the JAMA Internal medicine publication, patient care may be suffering at many hospitals because hospital physicians are often overloaded.  Concerns that clinicians at hospitals were stretched thin by excessive caseloads or fatigue led to restrictions on resident physician work hours; in some states, regulations intended to ensure nurse staffing at levels that optimize patient safety were enacted. Such efforts may have the unintended consequence of increasing the workload of attending physicians at hospitals, but there has been limited research on this and how it affects patient care and safety.  To provide some data on hospitalist workload, a research team from Johns Hopkins University in Baltimore surveyed a national sample of 890 physicians participating in QuantiaMD.com, an online community for physicians, and 57% of them responded.  The study found the following:

¢ 40 percent reported having too many patients to safely take care of each month.
¢ 36 percent reported that patient overloads occur once a week.
¢ 25 percent reported their workload is a barrier to thoroughly discussing treatment options with patients and their families.
¢ More than 20 percent said they ordered unnecessary procedures for patients, because they didn’t have enough time for a thorough evaluation.
¢ More than one in five reported their workload likely contributed to patient transfers, patient complications or death.

Many of the physicians reported that overwork caused them to default into a “do something, anything” treatment plan.
That’s not good for the patient, it’s a waste of resources and an abuse of the system. And, according the doctors surveyed, it œlikely contributed to patients being transferred, to increased morbidity (higher incidence of a disease or disorder) or mortality.

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The researchers have a couple of suggestions for improving the situation: regularly evaluating workloads for attending physicians, and cutting health-care costs without increasing workloads to compensate for payment reductions. In our opinion, the first is wish-list, perfect-world irony (who’s got the time to monitor people who don’t have the time not to need monitoring?), and the latter is an evergreen problem the system has long recognized and been unable to address. The survey isn’t a conclusive diagnosis of the overworked doctor problem because its respondents chose to participate (it wasn’t a random sample), and, potentially, there are differences between someone’s perceived workload as it relates to a patient’s outcome versus an actual workload with actual outcomes. Still. There’s a problem with doctors being able to do the best job they can with hospitalized patients. And at least for now, the best way to protect yourself and your loved ones is to monitor the care.

 

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