John Nelson writes…
Daily encounters are a good metric for financial analyses, but I think they’re not so good when thinking about quality of care or hospitalist career longevity.
Most groups track the average number of encounters per hospitalist each day (or rounding) shift. And everyone wants to know what it the right or SHM recommended average number of daily encounters. When does an increasing average encounter volume begin to impair quality of care?
I often hear people say something like “SHM says a hospitalist should see X patients daily.” In fact, SHM doesn’t have an official position regarding the optimal or appropriate daily patient volume for a hospitalist. SHM’s biannual survey of hospitalist practice provides good data regarding what patient volumes are typical for hospitalists, but that isn’t the same thing as what volumes are best for patient outcomes or hospitalist career longevity.
No great data exist to demonstrate what patient volume threshold begins to adversely affect quality, or increase hospitalist burnout. There are some small studies (e.g., here and here and others) that shed some light on the issue but don’t really provide a definitive answer. Of course the lack of research data doesn’t keep people from being convinced they know what the uppermost safe patient volume is, and arguing passionately for their point of view. And that is just fine. There are a lot of thoughtful people who have a lot of experience with the issue and their opinions are worth something.
And I’ll offer my opinion. I think that seeing more than 20 billable encounters in a day with any regularity is not a good idea. I prefer to see more like 12 – 15 encounters most days.
A better question than what is an optimal or safe average daily encounter volume might be to ask how often volume it exceeds a threshold you’ve chosen. When thinking of patient safety and hospitalist burnout, I’m less concerned with the average number of daily encounters, and more interested in how often the hospitalist has to see more than 20 encounters in a day. I think most hospitalists should see 20 (maybe 18 instead?) encounters in a day no more than about once or twice a month, regardless of what their average daily encounter volume is.
Don’t make too much of the threshold of 20 (or 18) that I’ve chosen since I don’t have any great data to support it. I’m sure there are some individuals who could safely see more than 20 patients daily on a regular basis, but my experience suggests they’re the exception rather than the rule.