A heavier workload for hospital residents was associated with increased length of hospital stay, total costs and risk of inpatient death, according to a report in the January 8 issue of the Archives of Internal Medicine.

Outcome risks increased substantially when teams admitted more than 9 patients a day. 

New duty-hour reduction requirements for house staff have led to substantial changes in residency team structures. It was hoped the reduction would improve or, at worst, have no effect on patient outcomes. 

Michael Ong, M.D., Ph.D., of the University of California, Los Angeles, and colleagues conducted a retrospective analysis to determine the association between house staff workload on a patient’s day of admission or on subsequent hospital days and patient outcomes. They analyzed data on 5,742 adults who were admitted to the General Medicine Service at the University of California, San Francisco’s Moffitt-Long Hospital between July 1, 1998, and June 30, 2001. 

The data showed two different measures of the workload were significantly associated with patient outcomes. Each additional admission by a residency team increased the length of stay, total costs and risk of dying in the hospital for each patient who was admitted on that day. It was also found that risks increased even more substantially when the team admitted more than nine patients. 

However, after a patient was admitted, it was found that a higher average census was associated with reduced resource use and decreased length of patients’ stay and total costs. The largest reductions occurred with a patient load of greater than 15. 

The authors concluded that programs may want to reduce team admission loads as well as maximize availability of other resources on non-admitting days.


JAMA – AMA Archives Media Release

House Staff Team Workload and Organization Effects on Patient Outcomes in an Academic General Internal Medicine Inpatient Service. Arch Intern Med. 2007;167:47-52.

About the Author

Jeanne Bohm, Ph.D. is a cancer biologist by training, a medical writer and an experienced science educator.

The author has no financial relationship to any of the companies listed in the article.

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Topics #Inpatient Deaths #Patient Outcomes #Resident Workload