- Raymund B. Dantes, MD, MPH and
- Daniel D. Dressler, MD, MSc, SFHM, FACP
What is the relation among physician workload, quality of care, and efficiency? To answer this question, researchers in Delaware conducted a retrospective cohort study of 20,241 inpatient admissions to their (primarily nonteaching) hospitalist services at two hospitals (1 tertiary care, 1 community; 1071 total beds). Outcomes were adjusted for multiple factors, including severity of illness, provider continuity, hospital occupancy, and test turnaround time.
On average, hospitalists managed 15 patients and accrued 29 Relative Value Units (RVUs) billed daily. As census and RVUs increased, both hospital length of stay (LOS) and cost of hospitalization increased. Cost per hospitalization and LOS increased for each additional patient managed, although the rate of increase depended on total hospital occupancy. Average patient LOS was 2 days longer and average cost was more than US$5000 higher for a hospitalist with 22 patients daily versus a hospitalist with 11 patients daily. Increasing hospitalist census did not significantly affect patient satisfaction or care quality measures (in-hospital mortality, 30-day readmission rates, or number of rapid response team activations).
Dr. Dantes is an Assistant Professor of Medicine at Emory University School of Medicine in Atlanta, Georgia.
Editor Disclosures at Time of Publication
Disclosures for Daniel D. Dressler, MD, MSc, SFHM, FACP at time of publication
Editorial boards Hospital Medicine Reviews; Journal of Hospital Medicine