Sanjay Galhotra, MD, MPH

Clinical question: Does intensive-care-unit (ICU) bed availability impact outcomes for hospitalized patients with sudden clinical deterioration?

Background: ICU beds are a scarce resource, and their availability might affect the care delivered to hospitalized patients who deteriorate clinically.

Study design: Retrospective cohort analysis.

Setting: Three hospitals in Calgary, Alberta.

Synopsis: This study analyzed data for a retrospective cohort of 3,494 hospitalized patients who had a sudden clinical deterioration triggering a medical emergency team. The associations between ICU bed availability and three outcomes—likelihood of ICU admission, change in goals of care (from "resuscitative" to either "medical" or "comfort"), and hospital mortality—were examined.

Reduced ICU bed availability was associated with decreased likelihood of ICU admission and increased likelihood of a change in goals of care. When more than two ICU beds were available, 21.4% of patients with a clinical deterioration were admitted to the ICU, compared with 11.6% and 14.5% if zero or one bed was available. When more than two ICU beds were available, 8.5% of patients had a change in their goals of care, compared with 14.9% of patients who had a change in goals of care when zero ICU beds were available. ICU bed availability was not associated with in-hospital mortality.

Bottom line: Reduced ICU bed availability is associated with decreased likelihood of ICU admission and increased likelihood of changing goals of care to a less aggressive strategy.

Citation: Stelfox HT, Hemmelgarn BR, Bagshaw SM, et al. Intensive care unit bed availability and outcomes for hospitalized patients with sudden clinical deterioration. Arch Intern Med. 2012;172:467-474.

Clinical question: Does intensive-care-unit (ICU) bed availability impact outcomes for hospitalized patients with sudden clinical deterioration?

Background: ICU beds are a scarce resource, and their availability might affect the care delivered to hospitalized patients who deteriorate clinically.

Study design: Retrospective cohort analysis.

Setting: Three hospitals in Calgary, Alberta.

Synopsis: This study analyzed data for a retrospective cohort of 3,494 hospitalized patients who had a sudden clinical deterioration triggering a medical emergency team. The associations between ICU bed availability and three outcomes—likelihood of ICU admission, change in goals of care (from "resuscitative" to either "medical" or "comfort"), and hospital mortality—were examined.

Reduced ICU bed availability was associated with decreased likelihood of ICU admission and increased likelihood of a change in goals of care. When more than two ICU beds were available, 21.4% of patients with a clinical deterioration were admitted to the ICU, compared with 11.6% and 14.5% if zero or one bed was available. When more than two ICU beds were available, 8.5% of patients had a change in their goals of care, compared with 14.9% of patients who had a change in goals of care when zero ICU beds were available. ICU bed availability was not associated with in-hospital mortality.

Bottom line: Reduced ICU bed availability is associated with decreased likelihood of ICU admission and increased likelihood of changing goals of care to a less aggressive strategy.

Citation: Stelfox HT, Hemmelgarn BR, Bagshaw SM, et al. Intensive care unit bed availability and outcomes for hospitalized patients with sudden clinical deterioration. Arch Intern Med. 2012;172:467-474.

Clinical question: Does intensive-care-unit (ICU) bed availability impact outcomes for hospitalized patients with sudden clinical deterioration?

Background: ICU beds are a scarce resource, and their availability might affect the care delivered to hospitalized patients who deteriorate clinically.

Study design: Retrospective cohort analysis.

Setting: Three hospitals in Calgary, Alberta.

Synopsis: This study analyzed data for a retrospective cohort of 3,494 hospitalized patients who had a sudden clinical deterioration triggering a medical emergency team. The associations between ICU bed availability and three outcomes—likelihood of ICU admission, change in goals of care (from "resuscitative" to either "medical" or "comfort"), and hospital mortality—were examined.

Reduced ICU bed availability was associated with decreased likelihood of ICU admission and increased likelihood of a change in goals of care. When more than two ICU beds were available, 21.4% of patients with a clinical deterioration were admitted to the ICU, compared with 11.6% and 14.5% if zero or one bed was available. When more than two ICU beds were available, 8.5% of patients had a change in their goals of care, compared with 14.9% of patients who had a change in goals of care when zero ICU beds were available. ICU bed availability was not associated with in-hospital mortality.

Bottom line: Reduced ICU bed availability is associated with decreased likelihood of ICU admission and increased likelihood of changing goals of care to a less aggressive strategy.

Citation: Stelfox HT, Hemmelgarn BR, Bagshaw SM, et al. Intensive care unit bed availability and outcomes for hospitalized patients with sudden clinical deterioration. Arch Intern Med. 2012;172:467-474.

Clinical question: What are the current job satisfaction levels of hospitalists?

Background: The number of hospitalists is growing rapidly, and there are now estimated to be 30,000 hospitalists in the U.S. Despite this rapid growth, little is known about whether being a hospitalist is a viable long-term career choice or if hospitalists are prone to burnout. This study sought to examine the job satisfaction levels of hospitalists and assess their risk of burnout.

Study design: Survey.

Setting: A representative, stratified sample of practicing hospitalists who were members of SHM or had attended an SHM event were surveyed using the Hospital Medicine Physician Work-Life Survey, an instrument developed by SHM’s Career Satisfaction Task Force. The survey measured 22 domains, including general job and specialty satisfaction, specific satisfaction domains (e.g. compensation, workload, personal time), stress, burnout, and intent to leave.

Synopsis: A total of 816 hospitalists responded to the survey for a response rate of 26%. Nearly 63% of respondents reported high overall job satisfaction and 69% reported high satisfaction with hospital medicine as a specialty. The majority of respondents reported high satisfaction with care quality (82.3%), relationships with staff (79.5%), colleagues (76.2%), and their leaders (75.4%). A minority of respondents reported satisfaction with organizational fairness (31.2%), personal time (28.3%), compensation (27.9%), and autonomy (17.4%).

Burnout symptoms were reported by 29.9% of hospitalists. Among the respondents who reported burnout symptoms, many reported that they were “very likely” (24.6%) or “somewhat likely” (20.8%) to leave their current practice within two years.

The response rate was low and might not accurately reflect the opinion of non-SHM members.

Bottom line: Most hospitalists reported high satisfaction with their job and with the specialty of hospital medicine, but a significant minority reported burnout symptoms and a likelihood of leaving their current practice.

Citation: Hinami K, Whelan CT, Wolosin RJ, Miller JA, Wetterneck TB. Worklife and satisfaction of hospitalists: toward flourishing careers. J Gen Intern Med. 27:28-36.

Clinical question: What are the current job satisfaction levels of hospitalists?

Background: The number of hospitalists is growing rapidly, and there are now estimated to be 30,000 hospitalists in the U.S. Despite this rapid growth, little is known about whether being a hospitalist is a viable long-term career choice or if hospitalists are prone to burnout. This study sought to examine the job satisfaction levels of hospitalists and assess their risk of burnout.

Study design: Survey.

Setting: A representative, stratified sample of practicing hospitalists who were members of SHM or had attended an SHM event were surveyed using the Hospital Medicine Physician Work-Life Survey, an instrument developed by SHM’s Career Satisfaction Task Force. The survey measured 22 domains, including general job and specialty satisfaction, specific satisfaction domains (e.g. compensation, workload, personal time), stress, burnout, and intent to leave.

Synopsis: A total of 816 hospitalists responded to the survey for a response rate of 26%. Nearly 63% of respondents reported high overall job satisfaction and 69% reported high satisfaction with hospital medicine as a specialty. The majority of respondents reported high satisfaction with care quality (82.3%), relationships with staff (79.5%), colleagues (76.2%), and their leaders (75.4%). A minority of respondents reported satisfaction with organizational fairness (31.2%), personal time (28.3%), compensation (27.9%), and autonomy (17.4%).

Burnout symptoms were reported by 29.9% of hospitalists. Among the respondents who reported burnout symptoms, many reported that they were “very likely” (24.6%) or “somewhat likely” (20.8%) to leave their current practice within two years.

The response rate was low and might not accurately reflect the opinion of non-SHM members.

Bottom line: Most hospitalists reported high satisfaction with their job and with the specialty of hospital medicine, but a significant minority reported burnout symptoms and a likelihood of leaving their current practice.

Citation: Hinami K, Whelan CT, Wolosin RJ, Miller JA, Wetterneck TB. Worklife and satisfaction of hospitalists: toward flourishing careers. J Gen Intern Med. 27:28-36.

Clinical question: What are the current job satisfaction levels of hospitalists?

Background: The number of hospitalists is growing rapidly, and there are now estimated to be 30,000 hospitalists in the U.S. Despite this rapid growth, little is known about whether being a hospitalist is a viable long-term career choice or if hospitalists are prone to burnout. This study sought to examine the job satisfaction levels of hospitalists and assess their risk of burnout.

Study design: Survey.

Setting: A representative, stratified sample of practicing hospitalists who were members of SHM or had attended an SHM event were surveyed using the Hospital Medicine Physician Work-Life Survey, an instrument developed by SHM’s Career Satisfaction Task Force. The survey measured 22 domains, including general job and specialty satisfaction, specific satisfaction domains (e.g. compensation, workload, personal time), stress, burnout, and intent to leave.

Synopsis: A total of 816 hospitalists responded to the survey for a response rate of 26%. Nearly 63% of respondents reported high overall job satisfaction and 69% reported high satisfaction with hospital medicine as a specialty. The majority of respondents reported high satisfaction with care quality (82.3%), relationships with staff (79.5%), colleagues (76.2%), and their leaders (75.4%). A minority of respondents reported satisfaction with organizational fairness (31.2%), personal time (28.3%), compensation (27.9%), and autonomy (17.4%).

Burnout symptoms were reported by 29.9% of hospitalists. Among the respondents who reported burnout symptoms, many reported that they were “very likely” (24.6%) or “somewhat likely” (20.8%) to leave their current practice within two years.

The response rate was low and might not accurately reflect the opinion of non-SHM members.

Bottom line: Most hospitalists reported high satisfaction with their job and with the specialty of hospital medicine, but a significant minority reported burnout symptoms and a likelihood of leaving their current practice.

Citation: Hinami K, Whelan CT, Wolosin RJ, Miller JA, Wetterneck TB. Worklife and satisfaction of hospitalists: toward flourishing careers. J Gen Intern Med. 27:28-36.