Self-Reported Subjective Workload of On-Call Interns

摘要

What is known Traditional measures of physician workload, such as patients admitted or census, may not fully reflect the complexity of workload.;What is new A study assessed whether self-reported subjective workload was associated with traditional measures of workload.;Limitations Study was conducted prior to 2011 duty hour standards implementation; small sample size, and single-site study limit generalizability.;Bottom line Self-reported workload was not associated with traditional measures of physician workload, yet may assist in better allocation of resident work, contributing to enhanced patient safety.;Introduction Driven to a considerable extent by the duty hour limitations of 20031 and 2011,2 resident schedules have changed dramatically. Traditional concerns about fatigue3,4 and burnout5 have been at least partially replaced with new concerns about experience6 and workload.7 Workload and work intensity are related concepts, and both have been studied to a limited degree in physicians. Workload has been defined in the human factors literature as being the extent to which a person has used the cognitive and physical resources needed for task performance.8 Workload is usually conceptualized in medicine as the number of patients being cared for or the amount of work that needs to be done. Work intensity is more focused on the perceived experience of the worker with respect to the difficulty of a specific task or encounter.9 Work intensity can be thought of as a moderator of workload, so a fixed amount of work will require more cognitive resources (workload) if the intensity is higher. Physician workload seems to be important. In a 1993 survey study, residents reported that workload contributed to many serious patient care mistakes.10 A focus group study corroborated that workload was still an important factor in such mistakes after the 2003 implementation of duty hour limits.11 Work intensity has an impact on physicians as well. In a study of Swiss physicians, work intensity was found to be correlated with emotional exhaustion and aversion to patients.12 Previous work in anesthesia used a scale from ergonomics13 to measure the self-reported subjective workload (ie, work intensity) of physicians and nurses in the operating room.14 Building on these methods, we designed the following study. This was part of a larger study of the work of interns while on call. The aim of this part of the study was to examine the self-reported subjective workload of internal medicine interns as they worked during an on-call shift.;Methods Study Design This was a prospective observational study with a cross-sectional survey component. Some of the methods have been previously described.15;Results We had a participation rate of 69% (25 of 36), with a mean age of 28.6 (SD, 2.4) years and 56% (14) being women.15 Participants reported a mean of 4 (SD, 3.7) months in training. Interns started the day with a mean of 2.6 (SD, 1.6) patients, with a range of 0 to 5 patients. The mean team census at the start of the day was 7.2 (SD, 2.7), with a range of 2 to 12. They reported a mean of 3.9 (SD, 1.8) admissions. The mean number of patients cross-covered overnight was 27.7 (SD, 12.1), with a range of 6 to 50 patients. Self-reported subjective workload was measured a mean of 9.2 (SD, 2.0) times per intern, while observer-rated workload was measured a mean of 9.3 (SD, 1.9) times. Mean self-reported subjective workload was 12.0 (SD, 2.4), and mean observer-rated workload was 11.6 (SD, 1.8). These were highly correlated, (r??=??0.92, P?