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Associations between attending physician workload, teaching effectiveness, and patient safety
Author(s) -
Wingo Majken T.,
Halvorsen Andrew J.,
Beckman Thomas J.,
Johnson Matthew G.,
Reed Darcy A.
Publication year - 2016
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2540
Subject(s) - workload , medicine , patient safety , emergency medicine , odds ratio , medline , medical emergency , family medicine , health care , computer science , political science , law , economics , economic growth , operating system
BACKGROUND Prior studies suggest that high workload among attending physicians may be associated with reduced teaching effectiveness and poor patient outcomes, but these relationships have not been investigated using objective measures of workload and safety. OBJECTIVE To examine associations between attending workload, teaching effectiveness, and patient safety, hypothesizing that higher workload would be associated with lower teaching effectiveness and negative patient outcomes. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective study of 69,386 teaching evaluation items submitted by 543 internal medicine residents for 107 attending physicians who supervised inpatient teaching services from July 2, 2005 to July 1, 2011. MEASUREMENTS Attending workload measures included 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 considered were applicable patient safety indicators (PSIs), intensive care unit transfers, cardiopulmonary resuscitation/rapid response team calls, and patient deaths. Mixed linear models and generalized linear regression models were used for statistical analysis. RESULTS Workload measures of midnight census and daily discharges were associated with lower teaching evaluation scores (both β = −0.026, P < 0.0001). The number of daily admissions was associated with higher teaching scores (β = 0.021, P = 0.001) and increased PSIs (odds ratio = 1.81, P = 0.0001). CONCLUSION 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. Ongoing efforts by residency programs to optimize the learning environment should include strategies to manage the workload of supervising attendings. Journal of Hospital Medicine 2016;11:169–173. © 2016 Society of Hospital Medicine