patient load

[parc8]

Our administration feels that out hospital med service is inefficient. We work in groups of basically 1 PA with 1MD. Our census is usually in the 80-90 range PTs for the entire group. Each PA/MD group sees about 20 +or 5 daily, some of us work eight hours some work 12s. The MDs state that over 20 is a bit much for each duo to tackle daily on a consistent basis.

Just wondering what is your norm? and are there any listing that you know of that state national average hospitalist patient loads/day

thanks

[Eddie G]

back when I was in internal medicine I use to see thirty patients everyday including 5 new admissions everyday 5 to 12 days a week.. depending if it was my weekend to work.

 

In specialty I saw about 12 patients and approximately 10 consults everyday for a total of 22 in 7 hours

 

I have been in the Er now for many years and I see an average of 24-30 patients in 12 hours..

 

I think you guys are slow.. or you labs and imaging are not efficient, or the nurses do not carry out your orders on time

 

Ed

[ventana]

Our local hosp has PA and NP in place

 

Resident teams for docs are capped at about 12

 

20- seems reasonable

 

I would bring up the fact that resident teams are capped due to the guidelines ofhours worked. In the fact that you are more efficent you should see more, but you also only work 40 hours per week (not 80) so should be less.

 

Pull up the AAPA data on hospitalists- print it out and hand it to them as justification that 20 is okay...

[deborah212]

Ed- were the 30 pts/day you saw in IM inpatients? I can't even imagine!

 

I've also been wondering about the typical hospitalist load. On our service, 1 PA is typically paired with 2-3 MDs. The PAs typically have 8-12 pts while the MDs have around 10-14 with a census in the 140s. Our model is currently being reworked in anticipation of swelling up to the 200s this winter- then each PA will probably be seeing 15 pts each.

 

10 patients already feels like a lot to me. Answering pages alone takes a good chunk of time... then there's the 1-2 really sick ones that require extra care and a possible ICU transfer.

 

Under our current model, the PAs and MDs don't round together. Whoever gets to the pt first writes the long note and orders the appropriate management- usually touching base by page when this is done.

 

How do you guys feel with the 1:1 model? Do you round together?

[istat2]

Emergency and urgent care. Usually 25-40 per 9+ hour shift (depends on volume):eek:. Guess I'm do for a raise :D. Worse hammering I ever took was 51 pts in a 12 hour shift (not including the hours charting after). But I had lab/imaging in the department, along with a magnificent support staff (thank you boys & girls). By 6 hours in I was afraid I was going to die:(. By the 10th hour, I was afraid I wouldn't:p!

[parc8]

50 is a busy day in the ED. I work in the ED as well commonly seeing 25 -30 in 8hrs. But inpatient medicine is different animal and much more time consuming on a per patient basis. I am not saying it is more busy I know EM gets crazy. I have also worked on many very busy surgical services and that is an all together thing as well. I did a bit of internet searching and found that most see 15-20 PTs / day range was anywhere between 6-20/day. This is for hospital medicine patients. Dealing with the families/PCP/ multiple medical issues/dictations/consultations ect really can eat up time. Also most of our patients have no recent med care and many issues, there are still groups of private docs that admit there own patients that they know well here.

[Febrifuge]

EM is a totally different thing. Remember, that 30 or 50 patients a shift includes all those who get to GO HOME after some labs or imaging, and/or the "therapeutic wait." By definition, hospitalists are seeing people sick enough to be inpatients, so the time-per-patient should be on average greater (including time running down results, talking with consulting providers, responding to pages, blah blah blah).

 

Plus, in the ED it's usually clear what can wait and what has to be done right now; there's a more herterogenous mix of urgency or severity. And while juggling patients is a core skill in both settings, PAs in the ED usually have their own territory and the ability to juggle based on their own needs and priorities. Sure, you might have to wrangle the attending MD for something, but if he/she is occupied you can see another patient in the meanwhile. On the med floor, it really depends on how the team is set up.

 

I don't have a lot of experience yet as a hospitalist, but what I've seen is that for a given patient, you might get them to the next step in the plan, but there's frequently a need to circle back at a moment's notice because somebody else's schedule makes it possible to pick up an important detail NOW: the consultant has finally called back, the imaging suite is finally ready, the patient finally graduated to solid food. Thus, the day can be really tough to plan. You go from step A to B to K to L to C to D to M to E.

 

My group divided it up such that only the MDs actually carry a list of patients. We PAs are tasked with admissions and discharges, and if we have time to make it to rounds, that's great. If we're doing the admission H&P or squaring away the mountain of paperwork, the MDs would much rather we do that than dash around the hospital nailing Jell-o to the wall.

 

We have 11 MDs and four PAs. Two of each are in the house from 8am to 8pm, with one overnight MD. Our census usually hovers in the 60s or 70s, but because of changes to the practice structure and the hospital system, we anticipate breaking 100 soon, and staying there.

[Eddie G]

Deborah

 

It was painful, thats why I left.. after a couple of years... I was at the hospital everyday at 05:50 and I left most days at 20:00... The only reason I did it was , the money. It was insane!!!

 

15 patients is easy. I'm done with that in 5 hours tops, but then I again I would look up labs from home, and I gave admission orders on most patients...

 

Phone orders, yoU have to develop long prn lists.. that is the key to reducing BS calls...

 

I never consulted the attending, just did what needed to be done, he would come by later and order anything else he wanted.. That eliminated more BS phone time..

 

We never rounded together, we were on opposite floors every other day.. that way my notes always got done... they only time we worked together was dictating d/c summaries everyday before or after rounds..

 

Ed :)

[PASims]

Curious for those working in the Hospitalist specialty. What is your schedule and responsibilities?

 

At my current location we work 3 12 hour shifts, no weekends or nights. We are not assigned MD/DO (Attendings). We take the number of patients on our census that morning and divide it by the number of PA's working that day on the floor. We rotate our admissions with the number of PA's working that day, somedays we only have 1 admission each other days some get 3 admissions. We go to case management meetings to discuss d/c planning and SW issues that present with the pts on our list that day. We do not follow the same pt during the same admission most of the time. We call our attendings that are assigned to the pt to discuss issues that may arise. Curious to see how others in the hospitalist setting run, we are trying to find ways to improve the satisfaction among PA's and the Attendings along with our hospital administration.

 

Thanks in advance

[PASims]

Curious for those working in the Hospitalist specialty. What is your schedule and responsibilities?

 

At my current location we work 3 12 hour shifts, no weekends or nights. We are not assigned MD/DO (Attendings). We take the number of patients on our census that morning and divide it by the number of PA's working that day on the floor. We rotate our admissions with the number of PA's working that day, somedays we only have 1 admission each other days some get 3 admissions. We go to case management meetings to discuss d/c planning and SW issues that present with the pts on our list that day. We do not follow the same pt during the same admission most of the time. We call our attendings that are assigned to the pt to discuss issues that may arise. Curious to see how others in the hospitalist setting run, we are trying to find ways to improve the satisfaction among PA's and the Attendings along with our hospital administration.

 

Thanks in advance

[crank]

Hello Parc8,

Hospitals management need to maintain certain count for patient admit. Based on the workers in hospital, they need to maintain count. Serving patients is critically important, because you are giving life to them.

[crank]

Hello Parc8,

Hospitals management need to maintain certain count for patient admit. Based on the workers in hospital, they need to maintain count. Serving patients is critically important, because you are giving life to them.

[DizzyJ]

I work 3-4 12's a week.  My group meets each morning with LSW and d/c planner (during the week).  We get report from night shift on new admissions and who is before or after midnight.  There are 3 of us on each day.  We split the list about equal and one person is assigned the admission pager.  If that person is hit with admissions/consults then when one of the other 2 of us are done we will pick up a couple new consults or just round on a couple of the admit guys patients.  Our service is 30-40 patients a day.  I usually see a dozen or so patients in my 12 hour shift that essentially is never actually twelve hours and I leave early all the time.  Pretty nice gig so far.