Patient outcomes often vary based on several factors. Environmental aspects, level of care, expectations, and communication all play an important role on both patient satisfaction and favorable outcomes. However, research also shows that a clinicians’ schedule may also impact outcomes as well. According to JAMA Internal Medicine, patients seen by hospitalists who worked fewer days had higher mortality, while patients treated by physicians with more days worked clinically exhibited lower mortality.
As hospitalists balance their schedules, spending more time in areas such as research, and giving attention to administrative and family obligations, the care of their patients may have more to do with their consistency at the bedside than originally realized. Since quality of care may in fact depend on time a hospitalist spends with a patient, working a more robust schedule could be highly beneficial. In the JAMA Internal Medicine study,
“a cross-sectional analysis was completed on a 20% random sample of Medicare beneficiaries 65 years and older who were admitted to the hospital with an emergency medical condition and treated by a hospitalist in 2011 through 2016. The associations between the number of days per year worked by hospitalists and the 30-day mortality rates among patients treated were examined, divided into quartiles of clinician days worked.” (1)
“The 30-day mortality was higher among patients treated by clinicians in the bottom quartile with the fewest number of days worked, compared with those treated by clinicians in the top quartile with the most days worked (10.5% vs. 9.6%). The rates were similar in the second and third quartiles (10.0% and 9.5%). The average number of days worked clinically per year was 57.6 in the lowest quartile versus 163.3 in the highest quartile, a 65% difference.” (2)
Researchers offered up several explanations as to why working fewer clinical days could be associated with higher patient mortality. One suggestion was that as hospitalists work fewer days, they are exposed to fewer guideline updates and less patient interaction. This inevitably could cause a decrease in skillset over time. While more research may be needed to entirely comprehend the full spectrum, it is clear from the above research that the more time a clinician spends with a patient, the better off they will likely be. And just because a hospitalist works part time, does not mean they will automatically have lower patient outcomes.
Understandably, there will be a wide range of hospitalists who will not follow conventional full time work schedules, and because of that, leadership should take extra measures to ensure outstanding consideration for satisfaction and favorable outcomes for both their staff and patients. Institutional support may be needed in the case of hospitalists spending reduced clinical time due to competing responsibilities. Types of assistance may include reduced caseloads, job sharing, and additional training opportunities.
Do you have a suggestion on how to increase patient outcomes with a limited work schedule, or an example of what worked for you in your organization? Share it with us! We’d love to hear from you!
Learn More About Advanced Care Hospitalists (ACH)
ACH is a Lakeland-based hospitalist group providing comprehensive patient care in community hospitals across Central Florida. Our providers are highly skilled, board-certified internal medicine specialists who are available around-the-clock to meet the care needs of patients from hospital admission through discharge. Post-discharge from the hospital, we continue overseeing patient care for 30 days.
We’ve found that continued care coordination ensures more accurate medication reconciliation, improved compliance with discharge plans, better scheduling of follow-up visits, and fewer hospital readmissions. Our providers do everything in their power to make sure our patients receive the compassionate and comprehensive care they need to promote healing and prevent a second hospital admission.
For more information about our services and our practice, please contact Advanced Care Hospitalists at 863-816-5884 or fill out a contact form online.
- Goodwin JS. Outcomes of Care by Hospitalists: Do Their Schedules Matter? JAMA Intern Med. 2021;181(11):1469–1470. doi:10.1001/jamainternmed.2021.5246
- Splete, Heidi. Fewer Inpatient Work Hours Linked with Worse Patient Outcomes. MDedge. 2021. https://www.mdedge.com/internalmedicine/article/246084/business-medicine/fewer-inpatient-work-hours-linked-worse-patient#:~:text=Overall%2C%20the%2030%2Dday%20mortality,9.6%25