Original Research
Tuesday, October 15, 2024
08:30 AM–10:00 AM
Abstract
Introduction:
‘Decision fatigue’ (DF) is the impaired ability to make decisions following repeated acts of decision-making leading to poorer decision-making efficiency. DF in hospital medicine has broad implications as hospitalists now care for most hospitalized patients and most work for seven consecutive days. Pharmacists work alongside hospitalists to provide care to complex patients, yet little data exists to inform practice models to optimize outcomes.
Research Question or Hypothesis:
The concurrent use of pharmacologically contradictory medications (e.g stool softeners and anti-diarrheals) or the incidence of hypoglycemia increases on each successive day on service.
Study Design:
This was a retrospective evaluation of patients cared for by daytime hospitalists at a large academic center between January 1, 2022 and February 28, 2022.
Methods:
DF events (i.e., prescription of physiologically contradictory medications and hypoglycemia) were abstracted and attributed to each hospitalist and the day on service. Univariate descriptive statistics were collated to describe event rates and events by day of service.
Results:
Forty-five hospitalists (36% female) and their 2,319 patients were included. Patients had a mean age of 59.5 years (SD 17.3) and median length of stay of 7 days (IQR 4-13). The median maximum consecutive days on service for hospitalists was 8 (IQR 7-11). 319 DF events occurred on 1,326 hospitalist days of service (24.1%). When assessed by day of service, the event rate was highest on day one at 25.1%, followed by day two at 23.9%. Day seven, the last day of a typical hospitalist schedule, had an event rate of 17.6%.
Conclusion:
Contrary to our hypothesis, event rates were highest on the first day of service. These data suggest that pharmacist-hospitalist collaborations should consider the first day on service as the highest risk period for errors. The cognitive burden related to processing large amounts of new data, rather than DF may be a greater threat to patient safety in hospital medicine.
Presenting Author
Rachel Kruer PharmDThe Johns Hopkins Hospital
Authors
Lauren Czosnowski PharmD
Butler University
Sarah Jones PA-C
Indiana University Health - Adult Academic Health Center
Areeba Kara MD, MS
Indiana University
Kelsey Perry MD
Indiana University
TJ Streepey undergraduate assistant
Indiana University