Defining and measuring the effort needed for inpatient medicine work.

BACKGROUND

Current metrics for assessing physician workload are inadequate. Understanding the effort associated with work tasks could make workload assessments more robust.

OBJECTIVE

To assess the physical, mental, and psychological effort needed for the tasks performed by internal medicine doctors while admitting a patient to the hospital.

DESIGN

Cross-sectional survey.

SETTING

A single Midwest academic institution.

SUBJECTS

Internal medicine housestaff, hospitalists, and nonhospitalist internal medicine faculty.

MEASUREMENTS

Subjects rated 99 tasks across 3 domains: physical, mental, and psychological effort using a scale of 1-7 (1 = least effort, 7 = most effort). A composite effort score was calculated for each task and for each of 6 task categories: direct patient care, indirect patient care, searching for/finding things, educational/academic activities, personal/downtime activities, and other.

RESULTS

Overall, the most difficult task was going to codes, which was also the most difficult psychological task. The most difficult physical task was placing a central line, and the most difficult mental task was transferring an unstable patient to the intensive care unit. The easiest task was using the Internet. That was also the easiest physical, mental, and psychological task. Direct patient care was more difficult than indirect patient care overall (3.58 vs 3.21; P < 0.001).

CONCLUSION

We began the process of describing the workload of inpatient doctors by measuring the difficulty of the tasks they perform while admitting patients. To assess the relationship between workload and other outcomes (such as physician burnout and patient safety), it is essential that we be able to accurately measure workload.