Trends in Inpatient Admission Comorbidity and Electronic Health Data: Implications for Resident Workload Intensity

Area of Science:

• Internal Medicine
• Medical Education
• Health Informatics

Background:

• Duty hour regulations aim to improve resident well-being and patient safety.
• Concerns exist regarding resident workload compression and its impact on training and care.
• The increasing complexity of patient care and electronic health records (EHRs) may exacerbate workload issues.

Purpose of the Study:

• To assess trends in patient comorbidity and EHR data burden over a 15-year period.
• To evaluate the impact of these factors on internal medicine resident workload.
• To understand the implications for resident training and patient care within duty hour constraints.

Main Methods:

• Retrospective, observational study of internal medicine resident admissions.
• Analysis of 67,346 admissions over 15 years at a Veterans Affairs hospital.
• Measurement of patient comorbidity using the Charlson Comorbidity Index and EHR data burden (notes, medications, discharge summaries).

Main Results:

• Mean patient comorbidity, measured by the Charlson Comorbidity Index, significantly increased over the study period.
• Electronic health record (EHR) data burden, indicated by the number of notes, medications, and discharge summaries per patient, also increased.
• Both increasing comorbidity and EHR data burden were observed to impact resident workload.

Conclusions:

• Patient comorbidity and EHR data burden have demonstrably increased over the past 15 years.
• These escalating factors contribute to resident workload compression.
• Addressing these challenges is crucial for resident education and patient safety under current duty hour regulations.