February 9, 2013

Effect of Workload on Patient Safety

by Levin & Perconti

Patient safety advocates who are working to minimize medical malpractice usually leave no stone unturned when it comes to identifying solutions. It is one thing to properly identify the mistakes that occur, highlighting the prevalence of preventable errors. However, it is another to enact changes that minimize the errors. Awareness is a necessary but not sufficient step to improving patient care.

For example, everyone knows that operating on the wrong body part is an obvious, and unacceptable error. No doctor needs to be told otherwise. Additionally, it is relatively well-known, at least in the medical community, that these surgical errors are surprisingly frequent. Yet the errors still mount up year after year. If it were only a matter of telling everyone “Don’t make surgical errors,” then the problem would have disappeared a long time ago.

Instead, more complex issues need to be addressed which contribute to the likelihood of certain mistakes being committed. Much of this involves playing the odds. The use of checklists during surgery, as an example, does not guarantee that no surgical errors will ever be committed. Conversely, not using a checklist does not automatically mean that mistakes will be made. But research has found that using the lists lowers the risk. If the ultimate goal is fewer mistakes, then using checklists is preferable to not using them.

Attending Physician Workload
Along the same lines, a new study published online last month took a look at the role that workload has on patient safety.

The authors explained that there has already been significant research into the effect of resident physician workload on patient safety. Residents are new doctors who are spending their first few years putting in significant house under the supervision of more experienced professionals. Research indicates that the most grueling work hours lead to clear increases in preventable medical errors. This past work has led many hospitals to cut back on resident work hours in an attempt to address patient safety.

However, resident work hours decreasing means that the slack must be picked up somewhere, likely with increased workload for attending physicians. This latest research effort therefore examines whether or not increased workload for attending physicians affected medical errors. This research involved surveys of various professionals to learn more about their work hours and the various effects they believe any changes may have on the care they provide.

What did they find?

The research indicates that a good number of doctors indicate the increase workload compromised the care that they provided patients. In some cases doctors even admitted that their workload led directly to medical errors. For one thing, about a quarter of doctors admitted that they could not fully discuss treatment options or answer patient questions because of time pressure from caseloads. Similarly, about 20% admitted generally that their total patient care level was too high for patient safety reasons.

A smaller, but still significant percentage of doctors even admitted to errors being committed. For example, 10% claimed that they did not follow up with lab results or certain complications in as timely a fashion because of the total number of patients for which they were responsible. Another 7% admitted that they made medication errors or other treatment mistakes because of the workload.

Importantly, these results are admitted directly from doctors. It is fair to say that most professionals underestimate their errors. And so these results should not be taken lightly.

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