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

Resident workload can significantly influence resident education, resident well-being, and patient care. Components of workload include duty hours and patient census, though their roles within the complexities of workload and subsequent effects remain underexplored. This scoping review aims to investigate how patient census impacts patient outcomes.

Our scoping review searched multiple databases in April 2022 using a query framework that captured articles reporting the effect of inpatient service census on patient outcomes. English-language studies conducted in the United States were included. Three authors independently screened results, followed by full-text review. The data extracted contained study characteristics, characterization of census, patient outcomes, and intervention utilization.

Thirteen articles met the inclusion criteria. The majority of articles (92.3%) were published after 2003, the time of the initial Accreditation Council for Graduate Medical Education duty hour restrictions mandate. All studies were conducted in internal medicine programs. Most commonly studied outcomes were readmission, length of stay, mortality, quality and safety measures, and patient satisfaction. Five studies performed an intervention to optimize census, which included adding residents to the team and implementing census caps. The overall paucity and heterogeneity of the present literature led to variable findings on how census affects patient outcomes.

There remains an incomplete understanding of the impact of patient census on patient outcomes and its role in workload, particularly among surgical specialties. Further efforts are needed to characterize the complexities of workload, compare differences in workload between surgical and nonsurgical specialties, and evaluate its impact on resident education, resident well-being, and patient care.