Hospital Costs, Length of Stay Increase with Workload of Hospitalists

 Daniel J. Elliott, M.D., MSCE, FACP Associate Chair of Research Department of Medicine and Research Scholar Value Institute, Christiana Care Health SystemMedicalResearch.com Interview with:
Daniel J. Elliott, M.D., MSCE, FACP
Associate Chair of Research
Department of Medicine and Research Scholar
Value Institute, Christiana Care Health System

MedicalResearch.com: What are the main findings of the study?

Dr. Elliott: The optimal workload for hospitalists has been a question since the earliest days of hospital medicine. However there has been very little empirical evidence to understand the relationship between workload and outcomes.

The objective of our study was to determine the association of daily workload for hospitalists on the efficiency, quality, and cost of care.  We analyzed data from a single private practice hospitalist group at a community-based health system between February 2008 and January 2011. Our research showed that both length of stay and cost increased for patients as hospitalist workload increased.

At the same time, our research showed that workload did not affect patient satisfaction as measured by HCAHPS scores or quality and safety outcomes including admissions, rapid response team activation and mortality.

MedicalResearch.com: Were any of the findings unexpected?

 

Dr. Elliott: We found that the association between hospitalist workload and efficiency of care differed somewhat based on the occupancy of the hospital.  When our hospitals were more full, the impact of hospitalist workload on length of stay was evident only at higher levels of workload.

It was reassuring to see that workload was not associated with decreased quality and safety.  This seems to indicate that hospitalists maintained the high level of care despite higher workloads.

Another finding of particular interest is that we did not identify a relationship among physician continuity, workload and outcomes.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Elliott:  While this study showed that an increase in hospitalists’ workload may be associated with an increased length of stay and higher costs, it also showed that hospitalists at every level of workload maintained the high level of care that prevents adverse events and readmissions and assures patient satisfaction.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Elliott:  There are likely many factors that contribute to the association of workload and outcomes, and it will be important to determine whether the associations we observed can be demonstrated in other practice settings. The challenge for all of us in healthcare is to maximize the value of the care we deliver, and studies like this one  can inform strategies to achieve better health outcomes at lower costs.
Citation:

Elliott DJ, Young RS, Brice J, Aguiar R, Kolm P. Effect of Hospitalist Workload on the Quality and Efficiency of Care. JAMA Intern Med. 2014;():. doi:10.1001/jamainternmed.2014.300.