Does End-of-Rotation Transition Affect Patient Mortality?

HealthDay News—Hospitalized patients who are handed off by their original medical team to a new set of caregivers may ultimately face a higher risk of early mortality, according to research published in the December 6 issue of the Journal of the American Medical Association, a theme issue on medical education.

Researchers looked at the experiences of 230,701 patients being cared for at one of 10 US Veterans Health Administration hospitals between 2008 and 2014. Most (95.8%) were men, average age 65.6, and the median hospital stay was just 3 days. Just over 2% of the patients died in hospital (2.18%), while 9.45% and 14.43% died within a month or 3 months after discharge, respectively.

Overall, the risk of dying both while in hospital or soon after discharge (at 30 and 90 days out) was significantly greater among those patients who underwent an end-of-rotation transfer while hospitalized, compared with those who didn’t. Elevated risk only went up significantly among transfers handled either by interns alone, or by an intern/resident team. Apart from training status, the apparent rise in mortality risk held up across age, gender, race, ethnicity, or length of hospital stay.

In a second study in the same journal, Charlie Wray, DO, from the San Francisco Veterans Affairs Medical Center, and colleagues examined routine adherence to national recommendations regarding ideal rotation policies, such as providing a dedicated time and place for patient hand-offs and/or ensuring hand-off supervision by senior physicians. The responses varied widely, with adherence ranging from just 6% in some cases to 67% in others, depending on the particular recommendation in question.

References

1. Denson JL, Jensen A, Saag HS, et al. Association between end-of-rotation resident transition in care and mortality among hospitalized patients. JAMA. 2016;316(21):2204-2213. doi: 10.1001/jama.2016.17424
2. Wray CM, Chaudhry S, Pincavage A, et al. Resident shift handoff strategies in US internal medicine residency programs. JAMA. 2016;316(21):2273-2275. doi: 10.1001/jama.2016.17786
3. Arora VM, Farnan JM. Inpatient service change: safety or selection? JAMA. 2016;316(21):2193-2194. doi: 10.1001/jama.2016.16398