Intern workload and patient satisfaction

The purpose of this study was to investigate the relationship between intern clinical workload and patient satisfaction. We hypothesized that the patients of interns with a heavier clinical workload would be less satisfied than the patients of interns with a lighter clinical workload. We collected data on all patients admitted to the Lexington VAMC with the primary diagnosis of congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) from 1/95-6/95. Eligible patients were those who were verbal, not from a nursing home, and not admitted initially to the intensive care unit Housestaff clinical workload was operationalized as number of patients for whom an intern was responsible on the day a patient was admitted ("patient census"), as recorded daily by each houseofficer. Patient Satisfaction was measured using the 10 item Aggregated EVGFP (1=excellent, 2=very good, 3=good, 4=fair, 5=poor) questionnaire as recommended by the ABIM, with the questionnaire filled out at time of discharge. For the 163 eligible patients, 156 (96%) answered the questionnaire regarding 44 different interns. The average "patient census" of the interns was 6.5 +/-2.7 patients (range 1-14). Mean satisfaction score of the trainees was 1.7 +/-0.9 (range 1 (excellent on all items) to 5 (all poor)). For 87 patients with COPD, the Pearson Correlation of intern "patient census" with better satisfaction scores was 0.34 (p=0.001). For the 58 patients with CHF, there was no significant correlation of "patient census" and satisfaction (r=-0.16; p=0.22). Controlling for patient severity-of-illness, type of resident call (long call vs. short call vs. nightfloat) and physician characteristics (e.g. gender) with multiple linear regression, we again found a significant association of "patient census" and patient satisfaction (p=0.003) for patients with COPD. Results were the same using logistic regression, dichotomizing satisfaction to Excellent/Very good vs. other. There was no association of patient satisfaction and "patient census" for patients with CHF. We conclude that for patients with COPD there is an association of intern clinical workload and subsequent patient satisfaction. Further research may suggest guidelines for the optimal clinical workload for interns to promote better patient satisfaction and other outcomes.