Associations between attending physician workload, teaching effectiveness, and patient safety.
The volume–outcome relationship—in which increased patient volume is associated with improved outcomes at the individual clinician and hospital level—has been demonstrated in several classic studies of surgical outcomes. However, this analysis of medical admissions to a teaching hospital found indications of an opposite association. Analyzing admissions over a 6-year period, investigators found that a higher total patient census and a greater number of daily admissions were both associated with an increased frequency of safety events (as measured by the AHRQ Patient Safety Indicators). Greater total census and more admissions were both inversely associated with teaching evaluation scores. Taken together, these results imply that increased workload impairs faculty physicians' ability to supervise and teach residents effectively.