Background: On the 2016 ACGME survey, our Internal Medicine residents indicated that our service vs. education rating was at 47% compared to the national average of 69%.
Purpose: To decrease resident physician workload to improve our education on inpatient wards, decrease the amount of non-physician level tasks to improve efficiency and to improve patient communication.
Description: We implemented the aid of a Medical Assistant (MA) on one of our six inpatient teams in July 2016. The MA was given a detailed outline of specific tasks, such as returning pages for the total duration of rounding time, initiating discharge paperwork, establishing outside discharge clinic appointments, obtaining outside records, and callbacks to discharged patients. Training was given for each task. In March 2017, we conducted a survey to assess the effectiveness of this intervention. For each question we used a 0-10 scale, 0 being “poor” and 10 being “excellent”, on the two survey instruments. A total of 40 faculty and residents responded. We formed two groups, the intervention ward team with the MA (MA 1) and 5 control ward teams with no MA (MA 0). The survey included questions regarding the quality of education on rounds (MA 1 mean = 8.0 vs. MA 0 mean = 6.9), service vs. education satisfaction (7.5 vs 4.4), timely outpatient follow up (8.1 vs 4.5), obtaining outside medical records (8.6 vs. 2.9), efficient completion of the discharge paperwork (8.3 vs. 3.7), efficiency on rounds (8.1 vs 5.5), pager response time (9.2 vs. 6.4), the total amount of time spent rounding (7.5 vs 5.4), time spent with patients (8.3 vs. 3.3), and time dedicated for education on rounds (7.5 vs 5.4). The survey data showed statistical significance (p <0.001) in the intervention group across all questions. The intervention group was 1 to 6 points higher in each measure.
In the free text comment section of the survey, overwhelmingly, the intervention group indicated that they were able to provide better patient care and communication, teach and acquire medical education at a higher quality during rounds without constant interruptions. They were able to perform clinical related tasks without being pulled away to conduct non-physician tasks such as request for medical records, initiation of discharge paperwork, responding to non-urgent pages and making outpatient clinic follow up appointments.
Conclusions: Residents and faculty are overwhelmed under constant demands of non-clinical administrative duties, adding to their overwhelming workload and subsequent burnout on inpatient teams. With the correct structure, the administrative support of Medical Assistants can be an effective intervention to provide higher quality of patient-care with an improvement in physician engagement and burnout prevention on inpatient wards. This is an example of an Ease of Practice project, with the goal of eliminating non-physician level administrative duties in order to create an environment where clinicians are able to utilize their professional skills to provide excellent care for patients and improve the training of future physicians.