Decision fatigue in hospital medicine: A retrospective exploratory evaluation.

Abstract

"Decision fatigue" (DF) is the deterioration in decision-making ability stemming from repeated decision making. Explore DF over the clinical workblock and across hospitalist and work characteristics. Patients seen by hospitalists at two hospitals in January and February 2022 were retrospectively evaluated for events that may reflect DF. Events were selected through multistakeholder discussion (prescription of pharmacologically antagonistic medications, occurrence of hypoglycemia, and potential overuse of blood transfusions, imaging, and penicillin alternatives). For each date, schedules determined the number of days each hospitalist had been on service and charges submitted assessed census and physician familiarity with their team. Charges and ordering data guided event attribution. The primary predictor was the number of days on service, and the outcome was event occurrence. Secondary predictors included hospitalist gender, weekend versus weekday, census, site, and degree of familiarity. During the study, 43 hospitalists worked 1306 days over 204 working blocks, providing care to 2081 patients over 3122 encounters. Median daily census was 13, median number of consecutive days worked was seven. DF events were not associated with the primary or secondary predictors except census. In the multivariable model, each one unit increase in the number of patients was associated with event occurrence (odds ratio [OR]: 1.107, 95% confidence interval [CI]: 1.022-1.198, p = .01). The odds of an event were 1.58 times greater at workloads above the median of 13 patients, compared with workloads ≤13. (p = .002). DF was not detected with an increasing number of days on clinical service. The findings highlight how workloads may threaten care quality.