Can time of day affect the treatment decisions of clinicians? According to a study by HMS researchers at Brigham and Women’s Hospital, it may, at least when it comes to the frequency with which clinicians prescribe antibiotics.
Clinicians make many patient care decisions each day, and the cumulative demand of these decisions may erode their ability to resist making inappropriate choices. This phenomenon, known as decision fatigue, has been documented in other professionals such as judges. The research team elected to study this phenomenon in medical professionals; their study looked at time of day and the associated rate at which physicians prescribe antibiotics for acute respiratory infections. Their findings indicate that doctors appear to “wear down” during their morning and afternoon clinic sessions and that rates for prescribing antibiotics increase as the sessions progress. The study appeared in the December 2014 issue of JAMA Internal Medicine.
“Clinic is very demanding,” says lead author Jeffrey Linder, an HMS associate professor of medicine at Brigham and Women’s. “In our study we accounted for patient characteristics, the diagnosis, and even the individual doctor, but still found that doctors were more likely to prescribe antibiotics later in the clinic session.”
The researchers merged billing and electronic health-record data for patient visits to 23 different primary care practices over the course of 17 months. They then identified visit diagnoses using billing codes and, using the electronic records, identified visit times, antibiotic prescriptions, and chronic illnesses. In all, they analyzed more than 21,000 acute respiratory infection visits by adults that took place during two four-hour sessions, 8 a.m. to noon and 1 p.m. to 5 p.m. The researchers found that the likelihood of prescribing antibiotics increased throughout each morning and afternoon clinic session.
“This corresponds to about 5 percent more patients receiving antibiotics at the end of a clinic session compared to the beginning,” says Linder.