Bringing Work Home from the Hospital
More and more Americans are working at least a portion of their jobs from home, facilitated by technological advances and encouraged by soaring gas prices. Even physicians, enabled by the spread of electronic health records (EHR), are increasingly able to perform some of their tasks at home, including updating patient records, checking lab results, and submitting orders for their patients. But for residents - the doctors-in-training who log the longest hours in the hospital - the ability to work at home can add even more burden to an already overstuffed schedule. In light of new national duty hour restrictions which limit residents to 80 hours a week, there could be increased pressure to push even more of their work to the home office.
However, few studies have looked at just how often these clinical activities already occur from home. To fill this gap, a team of Medical Center residents recently conducted a survey about the frequency of clinical and educational work done at home by their peers. The results of that study, published yesterday in the Archives of Internal Medicine, depict the double-edged sword of EHR home access: greater convenience and surveillance mixed with the potential for danger and abuse - especially as the new rules go into effect on July 1st.
“There are constantly new restrictions on duty hours but additions and new requirements in our training, which include more clinic time,” said Allison DeKosky, one of the study’s authors. “So we’re constantly logging in from home, not just to look up information for our research and education on our own time, but also to follow up on patient information that we simply couldn’t do in the hospital because we had to leave.”
The survey, conducted at two Chicago hospitals, found that performing clinical duties at home is commonplace. A majority of residents reported checking and ordering labs, reviewing records, e-mailing or paging staff at the hospital, and conducting clinic phone calls and orders at least once per month. Of more concern, significant numbers reported performing such activities at least once on their post-call day - when residents are supposed to be recovering from a grueling 30-hour hospital shift.
“Working from home is not necessarily always bad,” said Vineet Arora, associate professor of medicine and faculty advisor on the study. “After all, with electronic health records, working remotely is part of modern-day physician practice. The key question for residency programs is where do you have to draw the line and say that’s unsafe.”
The potential missteps are many: sleep deprivation could interfere with medical decision-making, the information received via EHR may be incomplete or out-of-date, and orders from the resident at home and the team working in the hospital could be redundant or conflicting. So why do residents have such a tough time leaving their work at work? DeKosky said that it’s a combination of responsibility, communication concerns, and looking out for their fellow residents. When shifts change after a call shift, the resident must turn their patients over to another resident to cover in addition to the incoming resident’s own patient load. Not wanting to over-burden the cross-cover resident or worried that an important test result or order might get lost in the shuffle, the post-call resident may feel compelled to check in via the EHR from home.
“It’s hard for us to relinquish responsibility for our patients, we all care very much about them,” DeKosky said. “It is a balance between getting out of the hospital and maintaining your ownership of the patient.”
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