title: Influence of patient and provider factors on the workload of on-call physicians: A general internal medicine cohort observational study.
abstract: Factors associated with the physician workload are scarcely reported. The study aims to investigate the associated factors of on-call physician workload based on a published conceptual framework.The study was conducted in a general internal medicine unit of National Taiwan University Hospital. On-call physician workloads were recorded on a shift basis from 1198 hospitalized patients between May 2010 and April 2011. The proxy of on-call workloads included night calls, bedside evaluation/management (E/M), and performing clinical procedures in a shift. Multivariable logistic and negative binomial regression models were used to determine the factors associated with the workloads of on-call physicians.During the study period, 378 (31.6%) of patients had night calls with related workloads. Multivariate analysis showed that the number of patients with unstable conditions in a shift (odds ratio [OR] 1.89 and 1.66, respectively) and the intensive care unit (ICU) training of the nurse leader (OR 2.87 and 3.08, respectively) resulted in higher likelihood of night calls to and bedside E/M visits by the on-call physician. However, ICU training of nurses (OR = 0.37, 95% confidence interval: 0.16-0.86) decreased the demand of performing clinical procedures by the on-call physician. Moreover, number of patients with unstable conditions (risk ratio [RR] 1.52 and 1.55, respectively) had significantly increased the number of night calls and bedside E/M by on-call physicians by around 50%. Nurses with N1 level (RR 2.16 and 2.71, respectively) were more likely to place night calls and facilitate bedside E/M by the on-call physician compared to nurses with N0 level. In addition, the nurse leaders with ICU training (RR 1.72 and 3.07, respectively) had significant increases in night calls and bedside E/M by the on-call physician compared to those without ICU training.On-call physician workload is associated with patient factors and the training of nurses. Number of unstable patients in a shift may be considered in predicting workload. The training of nurses may improve patient safety and decrease demand for clinical procedure.
authors: Division of Hospital Medicine Department of Internal Medicine Department of Traumatology Center of Quality Management Department of Surgery, National Taiwan University Hospital Institute of Health Policy and Management, College of Public Health, National Taiwan University Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Nin-Chieh
authors: NC
authors: Hsu
authors: Chun-Che
authors: CC
authors: Huang
authors: Jih-Shuin
authors: JS
authors: Jerng
authors: Chia-Hao
authors: CH
authors: Hsu
authors: Ming-Chin
authors: MC
authors: Yang
authors: Ray-E
authors: RE
authors: Chang
authors: Wen-Je
authors: WJ
authors: Ko
authors: Chong-Jen
authors: CJ
authors: Yu
mesh_terms: D000368:Aged; D003422:Critical Care; D064648:Critical Care Nursing / Q000193:education; D005260:Female; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration*; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling; D013624:Taiwan; D016526:Workload