Safety in Numbers: A Scoping Review of Patient Census and Patient Outcomes

Area of Science:

• Medical Education
• Patient Care
• Healthcare Management

Background:

• Resident workload is a critical factor influencing resident education, well-being, and patient care.
• Components of workload, such as duty hours and patient census, have complex interactions that are not fully understood.
• The specific impact of patient census on patient outcomes requires further investigation.

Purpose of the Study:

• To conduct a scoping review investigating the impact of patient census on patient outcomes.
• To explore the relationship between patient census and various aspects of resident workload.

Main Methods:

• A comprehensive literature search was conducted across multiple databases in April 2022.
• Included were English-language studies from the United States examining the effect of inpatient service census on patient outcomes.
• Data extraction focused on study characteristics, census details, patient outcomes, and intervention use.

Main Results:

• Thirteen articles met the inclusion criteria, with most published after 2003.
• Studies were exclusively from internal medicine programs, examining outcomes like readmission, length of stay, mortality, and patient satisfaction.
• Interventions to optimize census, such as adding residents or implementing caps, were noted in five studies.
• Findings on how census affects patient outcomes were variable due to literature paucity and heterogeneity.

Conclusions:

• A comprehensive understanding of patient census's impact on patient outcomes and workload is lacking, especially in surgical specialties.
• Further research is necessary to elucidate workload complexities and compare differences between surgical and nonsurgical specialties.
• Evaluating the impact of workload on resident education, well-being, and patient care is crucial.