Monday, July 18, 2016

Monthly resident handoff of patients may increase risk of dying

Public Release: 16-May-2016
Monthly resident handoff of patients may increase risk of dying
American Thoracic Society

Transitions in care that occur when medical residents leave a clinical rotation and turn their patients' care over to another resident is associated with increased mortality, according to new research presented at the ATS 2016 International Conference.


"Most hospitals have guidelines for the handoffs that occur on a daily basis, and usually those handoffs include a face-to-face discussion between doctors about what will happen to the patient during the next shift," Dr. Denson said. "But few have guidelines for this monthly handoff, in which a resident turns over for good the care of 10 to 20 patients, often in an email or telephone conversation."


Among patients in the 3 handoff groups, researchers found a:

64 to 95 percent increase in in-hospital mortality.
76 to 82 percent increase in 30-day mortality.
72 to 84 percent increase in 90-day mortality.

Researchers then adjusted for potential confounding factors, including age, comorbidities, length of stay and race and ethnicity. They found that the associations between 30-day and 90-day mortality and the 3 types of handoffs remained statistically significant. In-hospital mortality remained statistically significant only for intern handoffs. Researchers said study outcomes were similar across the 10 hospitals.

Dr. Denson said the stronger 30-day and 90-day mortality findings were a surprise. He speculated that the transition in care could lead to medication or other discharge errors because the new intern or resident lacked a complete picture of the patient. But, he added, "We don't know the root cause of this."


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