Unsafe Workloads in Hospital Medicine

So, if you’re listening to my new podcast (insert shameless plug for The Boston Health Podcast here), you’ll know that one of my favorite podcasts is Armchair Expert.  On this show, Dax Shepard and Monica Padman interview celebrities and experts in various fields.  It’s a fun show to listen to, and one the things they talk about all of the time is the Baader-Meinhof phenomenon (also called the frequency illusion).  In essence, it’s a cognitive bias that once you notice something, you begin to notice it everywhere, creating the illusion that it is more frequent than it really is.  Well maybe, I’ve just been thinking about physician overload too much lately, but I’m seeing it in strange places.

In the NY Times crossword puzzle on 10/19/20 (sorry for the spoilers, but if you happen to be more than a week behind on the Monday puzzle, you can stop reading here. . .) there was the following clue: Burden too heavily.  The answer to this clue (as you can probably tell by the opening paragraph) is: overload.  Now, I’m fairly certain that the writer/editors of that puzzle weren’t really thinking about hospitalists and patient workloads, but given my own biases, that’s what I immediately jumped to.

In addition to the real epidemic we’re dealing with in the world in 2020, there is also an “epidemic” of overloading physicians.  Even before 2020, we have been working our hospitalists too hard.  According to data (from a study published in JAMA in 2013), we’ve seen hospitalists frequently exceeding safe workload levels. This “excess workload prevented them from fully discussing treatment options, caused delay in patient admissions and/or discharges, and worsened patient satisfaction (Table). Over 20% reported that their average workload likely contributed to patient transfers, morbidity, or even mortality.”

Hospitalists often end up with unsafe workloads because the person making patient assignments doesn’t know how much patient care will be required.  Even though the doctors are given the same number of patients as their colleagues, and maybe even the same number of patients that they usually receive, on this particular day, the actual work involved in caring for those patients can be too high given the mix of these particular patients.  So the provider is left with an unsafe workload, and no one even knows that they might need help.  This is part of why I’ve been so excited about Assign.

When Assign automatically assigns patients to providers every day, it includes workload in its calculations.  So, while the doctors may not receive the same number of patients, they will get the same workload, and the system will alert the correct people if any/all of the doctors have an unsafe workload.

While medaptus can’t get rid of COVID altogether, I’m glad that we’re able to help our providers care for these patients and manage their workload in a safer manner.