How Patient Outcomes Can Suffer as the Day Goes On

Time is a valuable resource in the healthcare field. With so many patients to see, you can easily run short on time as the day goes on. Patients are often running late, and some appointments might take longer than expected. You may feel a little more fatigued, less focused, and increasingly impatient toward the end of your day. Long shifts are just part of the job, but several new studies suggest that treating patients later in the day can often lead to worse patient outcomes.

If you suspect that your patients may be getting the short end of the stick as the day goes on, learn more about these studies and how they may change your approach to scheduling.

The Trouble with Seeing Patients Late in the Day

Think about your normal workday and try to imagine yourself at the end of your shift. You’ve already seen dozens of patients, you’re tired, and you’re not sure if your brain can process any more incoming information. If this sounds familiar, you’re not alone.

A recent study published in JAMA Network Open shows that patients who went to see their primary care providers for acute pain at the end of the day were more likely to receive a prescription for opioids than those that saw their doctor earlier in the day. Opioid painkillers come with serious side effects that often lead to addiction.

In another study published in JAMA, patients who visited their doctors later in the day were less likely to receive recommended cancer screening tests, like mammograms than morning patients were. Based on the data, clinicians ordered mammograms for 63.7% of eligible patients during 8 A.M. appointments, while 33% of patients actually received the mammogram. However, during 5 P.M. appointments, clinicians prescribed mammograms to only about 48% of eligible patients — and just 17.8% of the patients scheduled and completed them.

What’s Going On?

The reasons behind these trends remain unclear, but they are likely related to the fact that providers get tired as the hours go by. When it comes to prescribing opioids, some doctors may be looking for a quick fix at the end of a long day instead of coming up with a more sound, responsible solution to the patient’s pain, such as physical therapy. For example, physical therapy and other alternative pain-relief methods may take weeks to show results and some patients may not be willing to wait.

The studies also suggest that doctors may be less willing to have difficult, complex conversations at the end of the day, such as why it’s important to sign up for cancer screenings or whether the doctor is taking the patient’s symptoms seriously, even though they refuse to prescribe opioids.

Both patients and providers may be less willing to have these discussions at the end of the day. Your patients may be just as exhausted and short on time as you are, but that doesn’t mean you have to ignore these issues entirely. If you get the sense that your patients don’t have the time to talk about their health, you can always send them home with additional information or remind them to schedule a follow-up.

Making the Best of the Situation

Working fewer hours or shorter days may seem like the ideal solution, but that’s probably not realistic. If you and your team need to work long shifts and see dozens of patients in a single day, use these tips to make sure all your patients receive the same quality of care:

• Try to schedule urgent appointments, chronically ill patients, or those with complex, difficult healthcare needs earlier in the day. Push follow-ups and routine exams towards the end of the day.
• Pad your schedule at the end of the day, so you have more time with patients who visit later in the afternoon. Rushing through a 20-minute session around 5 P.M. will only make matters worse, especially if you’re running behind already. Give yourself plenty of time with these patients to make sure you don’t miss anything important.
• Try sending out digital reminders to encourage your patients to sign up for cancer screenings. You can also end the appointment by mentioning that you’d like to talk about cancer screenings or physical therapy the next time the patient comes in for a visit. Encourage them to come back soon, so you can follow up with more information.
• It’s important to remember that some cancer screenings do not require a prior face-to-face consultation with a primary care provider. If one of your patients is interested in one of these procedures, they may not have to wait for your express approval.
• You can also have medical assistants or nurses talk to your patients about their everyday health and managing their condition. The doctor can then come in and focus on treatment to improve efficiency. This way, the doctor will have more time to review results and make informed decisions.

All your patients deserve the same quality of care. Use these tips to make sure you’re still at the top of your game towards the end of the day.