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Acute Care/Hospitalization

Mandatory limits on medical resident work hours may constrain hospital house staff and affect patient outcomes and resource use

Mandatory limits on the working hours of medical residents (house staff) may constrain the work of hospital house staff teams. This may affect patient outcomes and medical resources, suggests a new study. Researchers found, for example, that each additional team admission on a patient's admission day increased length of hospital stay by 3.1 percent and total costs by 2.3 percent. Doing the medical workup of a newly admitted patient is time-consuming, and more admissions reduce the time spent by teams on any one admitted patient. This can lead to inaccurate initial clinical assessment or push workup activity onto subsequent days. This, in turn, leads to longer hospital stays and higher total costs.

On the other hand, patients used fewer medical resources if cared for by teams with a high average census during the patient's stay, with no differences in patient readmission or mortality rates. An increase in house staff workload of each additional patient added to the team average census reduced length of stay by 5.3 percent and total costs by 5.11 percent.

Unlike admission volume, which cannot be modified by teams, team average census is a work measure that teams can control by adapting their daily tasks to meet workload demands, such as skipping teaching conferences to perform patient care tasks.

While this short-term workload improved efficiency, teams that were busier over the entire month-long rotation provided less efficient care. This suggests that fatigue may accumulate within teams over time. Finding ways to reduce team admission loads, while maximizing availability of other resources on nonadmitting days may help minimize total costs and lengths of stay, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS11416).

See "House staff team workload and organization effects on patient outcomes in an academic general internal medicine inpatient service," by Michael Ong, M.D., Ph.D., Alan Bostrom, Ph.D., Arpana Vidyarthi, M.D., and others, in the January 8, 2007, Archives of Internal Medicine 167, pp. 47-52.

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