Assessing the impact of workload and clinician experience on patient throughput: A multicenter study.

Abstract

Background: Various strategies have attempted to address increased patient lengths of stay (LOS), but effectiveness varies. Factors related to work design and workforce experience may also play significant roles.

Objective: Utilizing data from the Discharge in the A.M. trial, we aimed to validate an electronic measure of workload (i.e., note count) and assess the relationship of workload, patient complexity, and physician years of experience to LOS.

Methods: Retrospective observational study at three large academic hospitals with hospital medicine physicians and patients they care for during the study.

Measures: Workload as measured by electronic note count and physician years of experience; patient LOS.

Results: From February 9, 2021 to July 31, 2021, 59 physicians completed daily surveys for 93% of 2318 scheduled shifts. We observed a moderate correlation (r: .56) between starting morning census and note counts but no association with LOS. We observed an effect modification between note count and the Charlson Comorbidity Index (CCI), with LOS increasing by 2.3% (95% CI: 0.3%, 4.3%; p = .02) and 3.9% (95% CI: 2.0%, 5.9%; p < .0001) per patient for every 1 unit increase in note count for patients with a moderate CCI or severe CCI, respectively. Years since training was associated with a 0.7% decrease in LOS (95% CI: -1.3%, -0.1%, p = .03).

Conclusion: Physician workload, as measured by note count, was associated with longer LOS with higher CCI, while more years of experience was associated with shorter LOS. Original Clinical Trial Registration: ClinicalTrials.gov number, NCT05370638.