A new study published in the JAMA Internal Medicine journal shows that increasing hospitalist workload is associated with increases in patient length of stay and cost. Researchers from a Delaware healthcare system reviewed 20,241 inpatient admissions for a private hospital group working in a large academic community hospital system between February 1, 2008 and January 31, 2011. The researchers determined each hospitalist’s workload based on the relative value units (RVU) and patient encounters found in the hospital’s billing records. The researchers also adjusted their numbers based on hospital occupancy: low (<75%), medium (75% – 85%), and high (>85%). After crunching the numbers, the researchers found that the average LOS in low occupancy hospitals increased linearly from 5.5 days to 7.5 days as workloads increased. For medium occupancy hospitals, LOS was stable with lower workloads but increased exponentially when workloads exceeded 15 patients. For high occupancy hospitals, LOS dipped slightly in the midrange workload levels and then significantly increasing after the 15 patient threshold. While a previous survey results published in the same publication have showed hospitalists feel high workloads lead to increased morbidity and mortality and poor patient satisfaction, the Delaware study found that quality outcomes such as 7-day and 30-day readmissions rates, in-hospital mortality, and patient experience scores did not change when workloads increased. Still, the increase in cost could be enough to convince hospital leaders to invest in staffing additional hospitalists or use locum tenens hospitalists in cases where hospitalist workload exceeds 15 patients. The added costs associated with staffing additional hospitalist may pay off if it means workloads can stay below 15 patients. With that said, not all healthcare organizations are created equal. In a commentary letter, Robert M. Wachter, MD, wrote that hospital leaders should consider factors such as shift length and severity of illness when calculating proper workloads. The researcher also wrote that their findings should be validated in different clinical settings. However, healthcare organizations that are looking to control costs should consider hospitalist workloads. Here at Barton Associates, we have a large network of experienced locum tenens hospitalists, physician assistants, and nurse practitioners who can help organizations increase their staffing levels and manage hospitalist workloads.