Larger Hospitalist Workloads Associated with Increased Length of Stay and Costs, Study Finds

Increasing hospitalist workload is associated with reduced efficiency and higher costs, concludes a study published in the May 2014 issue of JAMA Internal Medicine. The study, which examined 20,241 inpatient admissions cared for by a private hospitalist group at a large academic community hospital system between February 1, 2008, and January 31, 2011, found that patient length of stay increased as hospitalist workload increased, particularly at lower levels of hospital occupancy. The data indicated that for hospital occupancies less than 75%, length of stay increased from 5.5 to 7.5 days as workload increased. For occupancies of 75% to 85%, length of stay increased exponentially above a daily workload of approximately 25 Medicare relative value units and a census value of approximately 15 patients, and for occupancies greater than 85%, length of stay increased significantly at higher ranges of workload. In addition, after controlling for length of stay, the results showed that cost increased by $111 for each 1-unit increase in relative value units and $205 for each 1-unit increase in census across the range of values.