Higher patient loads lead to delays in care, poor communication, delivery of unnecessary care, medication errors, and complications due to a faster, more hurried pace, hospitalists say.
But in the Delaware study, quality outcomes such as 7-day and 30-day readmissions rates, in-hospital mortality, and patient experience scores did not change, according to the JAMA report.
In an effort to identify a maximum patient load using real data, Elliott's project looked at outcomes and costs for 20,241 patients admitted between Feb. 1, 2008 and Jan. 31, 2011 at the Christiana hospitals.
It found that for every RVU unit increase in workload, the cost of caring for a patient rose by $111, and rose $205 for each one unit increase in census. In hospitals with census of 75%, length of stay increased from 5.5 to 7.5 days as workload increased. For hospitals with occupancy levels between 75% and 85%, length of stay increased exponentially.
And while this study stopped short of identifying the optimal hospitalist-to-patient ratio "it does help people understand that at some point, workload does have implications for efficiency of care," Elliott says.