Time of day and the decision to prescribe antibiotics
Linder and colleagues merged billing and electronic health record data from 23 primary care practices in one Boston-area health system, covering adult visits for acute respiratory infection in two four-hour weekday sessions between May 2011 and September 2012. After exclusions the sample was 21,867 visits by 204 clinicians, and 44 per cent ended in an antibiotic prescription. Using a model with clinician fixed effects, they found that the odds of a prescription rose across a session: about a quarter higher in the fourth hour than in the first, with a significant linear trend. The authors treat time within the session as a proxy for decision fatigue and list as limits a single health care system, scheduled rather than actual visit time, and possible unmeasured confounding. They note that other accumulating factors, such as general fatigue, could contribute.
Linder and colleagues merged billing and electronic health record data from 23 primary care practices in one Boston-area health system, covering adult visits for acute respiratory infection in two four-hour weekday sessions between May 2011 and September 2012. After exclusions the sample was 21,867 visits by 204 clinicians, and 44 per cent ended in an antibiotic prescription. Using a model with clinician fixed effects, they found that the odds of a prescription rose across a session: about a quarter higher in the fourth hour than in the first, with a significant linear trend. The authors treat time within the session as a proxy for decision fatigue and list as limits a single health care system, scheduled rather than actual visit time, and possible unmeasured confounding. They note that other accumulating factors, such as general fatigue, could contribute.
Written from the full text, PubMed Central, 2026-10-29.
What our sources record
Recorded when this source was checked, figures included, with page references and quotation marks removed.
Linder, J. A., Doctor, J. N., Friedberg, M. W., Reyes Nieva, H., Birks, C., Meeker, D., & Fox, C. R. (2014). Time of day and the decision to prescribe antibiotics. JAMA Internal Medicine, 174(12), 2029-2031. doi:10.1001/jamainternmed.2014.5225 https://doi.org/10.1001/jamainternmed.2014.5225