Background: Increased hospital utilization and admission can lead to increased provider stress and decreased hospital throughput. Hospital rounding and admitting service design may not appreciably change to accommodate for increased utilization. We hypothesized that a data-driven approach with targeting of hospitalist staffing during peak admission hours can alleviate provider stress and improve throughput during the admissions process.
Methods: The study was a prospective case-control study measuring physician perception of workload during the admission process. At our academic institution, one hospital added an additional admitting hospitalist to staffing, to meet an expected increase in admission demand. We studied the provider workload pre- and post- staffing change utilizing a survey validated to gauge real-time perceptions of work stress, called the NASA Task-Load-Index (TLX). The survey rates work stress on a 0-21 point scale across several domains, with 21 being the highest stress level. The TLX survey was distributed at 5:00PM, our peak admitting time, every day for 60 days to hospitalist admitters before and after the staffing change at one hospital, and at another control hospital in our system with stable admitter staffing and patient demand during the study. Hospitalist workload was measured as number of service patient admissions per hospitalist hour. The primary outcome was change in the pre-/post- intervention TLX survey results, related to workload. One secondary outcome was ED length of stay (LOS). Student’s t-test analysis was used to determine if the pre-/post- means were statistically significant after staffing change.
Results: A total of 52 surveys were collected before the staffing change, and 55 after. There was a decreasing trend in admissions per hospitalist-hour for the intervention group (0.847, 95% CI 0.578 – 1.118, vs 0.714, 95% CI 0.437 – 0.991; p 0.34). After staffing change was implemented at the intervention hospital, mean TLX survey results decreased in the domains of Temporal Demand (12.9 vs 9.7, p 0.004), Effort (13.0 vs 10.6, p 0.009), and Frustration (11.3 vs 7.7, p 0.005). There was no statistically significant difference between values in the control hospital for any TLX domain category. A trend in decrease in ED LOS from 202 minutes (95% CI 193 – 212) to 199 minutes (95% CI 190 – 208) was noted.
Conclusions: Staffing changes relative to the admitting process associated with improvement in hospitalist attitudes and real-time perception of workload. Associated reduction in burnout and ED LOS may also be present but requires further study to detect.