27 Nov Which Hospitalist Schedules Are Better for Patients?

MedicalResearch.com Interview with:
James S. Goodwin, M.D.
George and Cynthia Mitchell Distinguished Chair in Geriatric Medicine
University of Texas Medical Branch
Galveston, TX  77555-0177

MedicalResearch.com: What is the background for this study?

Response: Full time hospital doctors, called hospitalists, now provide the medical care for most patients hospitalized in the US. Depending on the hospital and also the hospitalist group, the working schedules of hospitalists can have vary greatly. For example, some might work 8 AM to 5PM for seven days followed by seven days off. Others might work 24 hours on and 72 hours off. Depending on the schedule of the hospitalists proving care, a patient  might have one or two or three or more different doctors proving care during their stay. Some patients see a new doctor each day.

Our goal was to see if patients who received care from hospitalists who tended to work several days in a row did better than those who were cared for many different hospitalists with intermittent schedules.

MedicalResearch.com: What are the main findings?

Response: We found that hospitalized Medicare  patients  cared for by hospitalists with more continuous schedules (e.g., working several days in a row for a  week or longer) had lower mortality after discharge and lower rates of readmissions than patients who were cared for by hospitalists with discontinuous schedules. Patients who were cared for by hospitalists with more continuous schedules were also more likely to go directly home after hospitalization rather than to a nursing home. 

MedicalResearch.com: What should readers take away from your report?

Response: There has been no prior information on this issue, so hospitalists have had had no data on which schedules are best for patients. We expect that these results will lead to a gradual change in hospitalist schedules to promote more continuity of care for patients in the hospital. 

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

Response: An issue that we did not study, but which is important, is physician burnout. Obviously, we can’t design a system where hospitalists work every day, or they would all go crazy, which would not be good for doctors or their patients. So work has to be done to find that balance between the ideal patient experience and acceptable working conditions for the hospitalists providing their care.

Citation:

Goodwin JS, Li S, Kuo Y. Association of the Work Schedules of Hospitalists With Patient Outcomes of Hospitalization. JAMA Intern Med. Published online November 25, 2019. doi: https://doi.org/10.1001/jamainternmed.2019.5193

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Last Updated on November 27, 2019 by Marie Benz MD FAAD