Monthly resident handoff of patients may increase risk of dying

http://www.eurekalert.org/pub_releases/2016-05/ats-mrh051016.php

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.

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"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."

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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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