A recent study published in the Journal of Hospital Medicine used objective workload and safety measures to support the previously unsupported notion that attending physicians with a high workload are typically linked with reduced effectiveness and poor patient outcomes.
The researchers conducted their study of more than 69,000 teaching evaluation items submitted by 543 internal medicine residents for 107 attending physicians. The evaluations covered supervised inpatient teaching services from July 2, 2005, to July 1, 2011.
To measure attending physicians' workload, the researchers analyzed hospital service census, patient length of stay, daily admissions, daily discharges and concurrent outpatient duties. Teaching effectiveness was measured using residents' evaluations of attendings. Patient outcomes were measured using applicable patient safety indicators, intensive care unit transfers, cardiopulmonary resuscitation/rapid response team calls and patient deaths.
Ultimately, the study revealed workload measures of midnight census and daily discharges were associated with lower teaching evaluation scores, and the number of daily admissions was linked with higher teaching scores and increased patient safety indicators.
"Several measures of attending physician workload were associated with slightly lower teaching effectiveness, and patient safety may be compromised when teams are managing new admissions," concluded the study authors. "Ongoing efforts by residency programs to optimize the learning environment should include strategies to manage the workload of supervising attendings."
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