Hospital patient loads often at unsafe levels, physician survey says

January 28, 2013

Nationwide, more than one-quarter of hospital-based general practitioners who take over for patients' primary care doctors to manage inpatient care say their average patient load exceeds safe levels multiple times per month, according to a new Johns Hopkins study. Moreover, the study found that one in five of these physicians, known as hospitalists, reports that their workload puts patients at risk for serious complications, or even death.

The research, reported in JAMA Internal Medicine, comes as health care systems anticipate an influx of new generated by the Act over the next few years; as restrictions on resident-physicians limit their duty hours; and as one in three physicians is expected to retire or otherwise leave medicine over the next 10 years, cumulatively resulting in increased patient care needs coupled with stressed staffing demands.

"As perceived by physicians, workload issues have the significant potential to do harm and decrease quality," says study leader Henry J. Michtalik, M.D., M.P.H., M.H.S., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine. "It is the elephant in the room that cannot be ignored. We have to find that balance between safety, quality and efficiency."

The Johns Hopkins study comprised a survey of 890 hospitalists across the United States, 506 of whom responded. Twenty-two percent of the respondents reported ordering costly and potentially unnecessary tests, procedures or consults because they didn't have time to properly assess patients assigned to their care.

"If a is short on time and a patient is having chest pains, for example, the doctor may be more likely to order additional tests, prescribe aspirin and call a cardiologist—all because there isn't adequate time to immediately and fully evaluate the patient," Michtalik says.

For the study, Michtalik, a hospitalist at The Johns Hopkins Hospital in Baltimore, and his colleagues electronically surveyed self-identified hospitalists enrolled in an online physician community, QuantiaMD.com. Of those who responded over the course of four weeks in November 2010, the average age was 38 years and more than half worked in community hospitals. Among other questions, physicians were asked to report what they felt was a safe number of patients to see in a typical shift. Most physicians reported that they could safely see 15 patients in a shift if they could focus 100 percent on clinical matters. When the average actual workload was compared to the perceived safe workload, 40 percent of physicians exceeded their own reported safe level.

Michtalik says that JHH's hospitalists typically stay below that number, while hospitalists at community hospitals often see more than 15 patients per shift.

"Hospitals need to evaluate workloads of attending , create standards for safe levels of work and develop mechanisms to maintain workload at safe levels," he adds.

Explore further: Frequently hospitalized patients may benefit from new medical specialty focused on their needs

Related Stories

Frequently hospitalized patients may benefit from new medical specialty focused on their needs

April 29, 2011
Declining rates of hospitalization have discouraged primary care doctors from seeing their patients in the hospital and encouraged the growing use of "hospitalists," a new physician specialty focused on the care of hospitalized ...

Recommended for you

Why sugary drinks and protein-rich meals don't go well together

July 20, 2017
Having a sugar-sweetened drink with a high-protein meal may negatively affect energy balance, alter food preferences and cause the body to store more fat, according to a study published in the open access journal BMC Nutrition.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

High-dose vitamin D doesn't appear to reduce the winter sniffles for children

July 18, 2017
Giving children high doses of vitamin D doesn't appear to reduce the winter sniffles, a new study has found.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.