{"id":"https://openalex.org/W2099697281","doi":"https://doi.org/10.1001/archinte.167.1.47","title":"House Staff Team Workload and Organization Effects on Patient Outcomes in an Academic General Internal Medicine Inpatient Service","display_name":"House Staff Team Workload and Organization Effects on Patient Outcomes in an Academic General Internal Medicine Inpatient Service","publication_year":2007,"publication_date":"2007-01-08","ids":{"openalex":"https://openalex.org/W2099697281","doi":"https://doi.org/10.1001/archinte.167.1.47","mag":"2099697281","pmid":"https://pubmed.ncbi.nlm.nih.gov/17210877"},"language":"en","primary_location":{"id":"doi:10.1001/archinte.167.1.47","doi":"https://doi.org/10.1001/archinte.167.1.47","is_oa":false,"landing_page_url":"https://doi.org/10.1001/archinte.167.1.47","pdf_url":null,"source":{"id":"https://openalex.org/S4210206803","display_name":"Archives of Internal Medicine","issn_l":"0003-9926","issn":["0003-9926","0730-188X","1538-3679"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core"],"host_organization":"https://openalex.org/P4310320259","host_organization_name":"American Medical Association","host_organization_lineage":["https://openalex.org/P4310320259"],"host_organization_lineage_names":["American Medical Association"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Archives of Internal Medicine","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5032533520","display_name":"Michael K. Ong","orcid":"https://orcid.org/0000-0001-8530-7754","observed_orcids":["https://orcid.org/0000-0001-8530-7754"]},"institutions":[{"id":"https://openalex.org/I161318765","display_name":"University of California, Los Angeles","ror":"https://ror.org/046rm7j60","country_code":"US","type":"education","lineage":["https://openalex.org/I161318765"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Michael Ong","raw_affiliation_strings":["Department of Medicine, University of California, Los Angeles, CA 90024, USA. michael.ong@ucla.edu"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, University of California, Los Angeles, CA 90024, USA. michael.ong@ucla.edu","institution_ids":["https://openalex.org/I161318765"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5032533520"],"corresponding_institution_ids":["https://openalex.org/I161318765"],"apc_list":null,"apc_paid":null,"fwci":5.4233,"has_fulltext":false,"cited_by_count":66,"citation_normalized_percentile":{"value":0.95554601,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":88,"max":99},"biblio":{"volume":"167","issue":"1","first_page":"47","last_page":"47"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12174","display_name":"Hospital Admissions and Outcomes","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12174","display_name":"Hospital Admissions and Outcomes","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11773","display_name":"Healthcare Operations and Scheduling Optimization","score":0.0003000000142492354,"subfield":{"id":"https://openalex.org/subfields/3604","display_name":"Emergency Medical Services"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11095","display_name":"Emergency and Acute Care Studies","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/team-size","display_name":"team size","score":0.44200000166893005},{"id":"https://openalex.org/keywords/in-hospital-mortality","display_name":"in-hospital mortality","score":0.6029999852180481},{"id":"https://openalex.org/keywords/length-of-hospital-stay","display_name":"length of hospital stay","score":0.9940000176429749},{"id":"https://openalex.org/keywords/hospitalization-costs","display_name":"hospital costs","score":0.925000011920929},{"id":"https://openalex.org/keywords/hospital-resource-utilization","display_name":"hospital resource utilization","score":0.5059999823570251},{"id":"https://openalex.org/keywords/academic-medical-centers","display_name":"academic medical centers","score":0.6119999885559082}],"concepts":[{"id":"https://openalex.org/C2778476105","wikidata":"https://www.wikidata.org/wiki/Q628539","display_name":"Workload","level":2,"score":0.918904185295105},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7607940435409546},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.6228789687156677},{"id":"https://openalex.org/C156957248","wikidata":"https://www.wikidata.org/wiki/Q1862216","display_name":"Odds ratio","level":2,"score":0.6226390600204468},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.5316691398620605},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.4809371829032898},{"id":"https://openalex.org/C143095724","wikidata":"https://www.wikidata.org/wiki/Q515895","display_name":"Odds","level":3,"score":0.4377692937850952},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.20927470922470093},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.11371096968650818},{"id":"https://openalex.org/C111919701","wikidata":"https://www.wikidata.org/wiki/Q9135","display_name":"Operating system","level":1,"score":0.0},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.0}],"mesh":[{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005500","descriptor_name":"Follow-Up Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005500","descriptor_name":"Follow-Up Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005500","descriptor_name":"Follow-Up Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006785","descriptor_name":"Hospitals, University","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":false},{"descriptor_ui":"D006785","descriptor_name":"Hospitals, University","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":false},{"descriptor_ui":"D006785","descriptor_name":"Hospitals, University","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007297","descriptor_name":"Inpatients","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D007297","descriptor_name":"Inpatients","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D007297","descriptor_name":"Inpatients","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D007396","descriptor_name":"Internship and Residency","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D007396","descriptor_name":"Internship and Residency","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D007396","descriptor_name":"Internship and Residency","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D007902","descriptor_name":"Length of Stay","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D007902","descriptor_name":"Length of Stay","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D007902","descriptor_name":"Length of Stay","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010043","descriptor_name":"Outcome and Process Assessment, Health Care","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D010043","descriptor_name":"Outcome and Process Assessment, Health Care","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D010043","descriptor_name":"Outcome and Process Assessment, Health Care","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D010359","descriptor_name":"Patient Readmission","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D010359","descriptor_name":"Patient Readmission","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D010359","descriptor_name":"Patient Readmission","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D012189","descriptor_name":"Retrospective Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D012189","descriptor_name":"Retrospective Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D012189","descriptor_name":"Retrospective Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016526","descriptor_name":"Workload","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D016526","descriptor_name":"Workload","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D016526","descriptor_name":"Workload","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D017052","descriptor_name":"Hospital Mortality","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":false},{"descriptor_ui":"D017052","descriptor_name":"Hospital Mortality","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":false},{"descriptor_ui":"D017052","descriptor_name":"Hospital Mortality","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":false}],"locations_count":2,"locations":[{"id":"doi:10.1001/archinte.167.1.47","doi":"https://doi.org/10.1001/archinte.167.1.47","is_oa":false,"landing_page_url":"https://doi.org/10.1001/archinte.167.1.47","pdf_url":null,"source":{"id":"https://openalex.org/S4210206803","display_name":"Archives of Internal Medicine","issn_l":"0003-9926","issn":["0003-9926","0730-188X","1538-3679"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core"],"host_organization":"https://openalex.org/P4310320259","host_organization_name":"American Medical Association","host_organization_lineage":["https://openalex.org/P4310320259"],"host_organization_lineage_names":["American Medical Association"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Archives of Internal Medicine","raw_type":"journal-article"},{"id":"pmid:17210877","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/17210877","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Archives of internal medicine","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.98580002784729,"display_name":"Good health and well-being"}],"sustainable_development_goals_aurora":[],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[{"id":"https://openalex.org/G1055969994","display_name":null,"funder_award_id":"K08HS11416-02","funder_id":"https://openalex.org/F4320332177","funder_display_name":"Agency for Healthcare Research and Quality"}],"funders":[{"id":"https://openalex.org/F4320332177","display_name":"Agency for Healthcare Research and Quality","ror":"https://ror.org/03jmfdf59"}],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":28,"referenced_works":["https://openalex.org/W1433110942","https://openalex.org/W1565240145","https://openalex.org/W1963746198","https://openalex.org/W1984821528","https://openalex.org/W1997441986","https://openalex.org/W2005785289","https://openalex.org/W2013214184","https://openalex.org/W2015403925","https://openalex.org/W2021807125","https://openalex.org/W2030738236","https://openalex.org/W2038746872","https://openalex.org/W2043157082","https://openalex.org/W2049837151","https://openalex.org/W2053484622","https://openalex.org/W2062160342","https://openalex.org/W2062648934","https://openalex.org/W2069496376","https://openalex.org/W2072410090","https://openalex.org/W2080751882","https://openalex.org/W2085814510","https://openalex.org/W2091424841","https://openalex.org/W2095329624","https://openalex.org/W2148082722","https://openalex.org/W2170210994","https://openalex.org/W2404040808","https://openalex.org/W2941588218","https://openalex.org/W3143377855","https://openalex.org/W4253854373"],"related_works":["https://openalex.org/W2337470350","https://openalex.org/W2110445512","https://openalex.org/W1989167146","https://openalex.org/W2080751882","https://openalex.org/W4248013451","https://openalex.org/W2043157082","https://openalex.org/W2171903817","https://openalex.org/W2157704636","https://openalex.org/W4290249914","https://openalex.org/W4281710892"],"abstract_inverted_index":{"BACKGROUND:":[0],"House":[1,83],"staff":[2,19,77,84,156,221],"work-hour":[3],"regulations":[4],"have":[5],"required":[6],"residency":[7],"programs":[8],"to":[9,43,146,170,184,194,254],"reengineer":[10],"inpatient":[11,124,236],"services.":[12],"However,":[13],"few":[14],"data":[15],"describe":[16],"how":[17],"house":[18,76,155,220],"workload":[20,78,85,157,222],"on":[21,28,87,98,149,223],"a":[22,99,239],"patient's":[23,100,161],"day":[24,89],"of":[25,39,75,90,105,123,177,199],"admission":[26,97,101,151],"or":[27],"subsequent":[29],"hospital":[30],"days":[31],"influences":[32],"patient":[33,63,81,168],"outcomes.":[34,82],"METHODS:":[35],"Retrospective":[36],"cohort":[37],"analysis":[38],"5742":[40],"adults":[41],"admitted":[42,145],"an":[44,134],"academic":[45],"general":[46],"medical":[47],"service":[48],"between":[49],"July":[50],"1,":[51],"1998,":[52],"and":[53,65,121,186,201,233],"June":[54],"30,":[55],"2001.":[56],"RESULTS:":[57],"After":[58],"multivariate":[59],"risk":[60,122,138],"adjustment":[61],"for":[62],"severity":[64],"other":[66],"structural":[67],"factors,":[68],"we":[69],"found":[70],"that":[71,218],"2":[72],"different":[73],"measures":[74],"significantly":[79],"affected":[80],"increases":[86,158],"the":[88,160,171,207],"admission,":[91],"defined":[92,164],"as":[93,165],"each":[94],"additional":[95,167],"team":[96,148,172,208,242],"day,":[102],"increased":[103],"length":[104,176,198],"stay":[106,178,200],"(difference,":[107,116,179,189],"3.09%;":[108],"95%":[109,118,129,181,191],"confidence":[110],"interval":[111],"[CI],":[112],"2.22%-3.96%),":[113],"total":[114,187],"costs":[115,188,202],"2.31%;":[117],"CI,":[119,130,182,192],"1.29%-3.33%),":[120],"mortality":[125,137],"(odds":[126],"ratio,":[127],"1.09;":[128],"1.02-1.15).":[131],"Patients":[132],"had":[133],"even":[135],"higher":[136,219,240],"when":[139,206],"more":[140],"than":[141],"9":[142],"patients":[143],"were":[144,203],"their":[147,150],"day.":[152],"In":[153],"contrast,":[154],"during":[159],"entire":[162],"stay,":[163],"every":[166],"added":[169],"average":[173,209,241],"census,":[174],"reduced":[175,247],"-5.30%;":[180],"-4.54%":[183],"-6.07%)":[185],"-5.11%;":[190],"-4.20%":[193],"-6.00%).":[195],"Reductions":[196],"in":[197,262],"most":[204],"striking":[205],"census":[210,243],"exceeded":[211],"15":[212],"patients.":[213],"CONCLUSIONS:":[214],"Our":[215],"findings":[216,261],"suggest":[217],"admitting":[224],"days-when":[225],"fewer":[226],"backup":[227],"resources":[228],"are":[229],"available-increases":[230],"resource":[231,248],"use":[232],"may":[234],"increase":[235],"mortality.":[237],"Conversely,":[238],"was":[244],"associated":[245],"with":[246],"use,":[249],"perhaps":[250],"reflecting":[251],"service-level":[252],"adaptations":[253],"workload.":[255],"Future":[256],"studies":[257],"should":[258],"confirm":[259],"these":[260],"larger":[263],"trials.":[264]},"counts_by_year":[{"year":2025,"cited_by_count":3},{"year":2024,"cited_by_count":2},{"year":2023,"cited_by_count":2},{"year":2022,"cited_by_count":3},{"year":2021,"cited_by_count":1},{"year":2020,"cited_by_count":1},{"year":2019,"cited_by_count":2},{"year":2018,"cited_by_count":4},{"year":2017,"cited_by_count":7},{"year":2016,"cited_by_count":2},{"year":2015,"cited_by_count":3},{"year":2014,"cited_by_count":5},{"year":2013,"cited_by_count":4},{"year":2012,"cited_by_count":6}],"updated_date":"2026-10-17T09:40:24.721904","created_date":"2016-06-24T00:00:00"}