HealthDay News – Transitions of patient care involving resident physician handoff was associated with increased in-hospital, 30-day, and 90-day mortality in 10 Veterans Administration hospitals between 2008 and 2014, according to findings presented at the annual meeting of the American Thoracic Society, held from May 13 to 18 in San Francisco.

The strongest degree of adjusted mortality risk was with patients whose care was transitioned and handled by interns, suggesting that length of training could be influencing these risks.

Researchers examined 230,701 patient discharges from 10 Veterans Administration hospitals that occurred between 2008 and 2014. The team identified 63,911 patients who died or were discharged within seven days of being transferred from the care of an intern, a resident, or a combination of the two. Other discharges included in the study served as a control group. The study authors also analyzed deaths that occurred 30 and 90 days after patients left the hospital.


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Among patients in the three hand-off groups, researchers observed a 64 to 95 percent increase in in-hospital mortality; a 76% to 82% increase in 30-day mortality; and a 72 to 84 percent increase in 90-day mortality. 

After taking other contributing risk factors into account, such as the patients’ age, health issues, and length of hospital stay, the researchers found that the link between hand-offs and deaths 30 days and 90 days after discharge remained significant at all 10 of the hospitals examined. The link between hand-offs and in-hospital deaths remained significant only with interns.

“Most hospitals have guidelines for the hand-offs that occur on a daily basis, and usually those hand-offs include a face-to-face discussion between doctors about what will happen to the patient during the next shift,” lead researcher Joshua Denson, MD, of the University of Colorado in Denver, said in a news release from the American Thoracic Society. 

“But few have guidelines for this monthly hand-off, in which a resident turns over for good the care of 10 to 20 patients, often in an e-mail or telephone conversation.”

Reference

Denson JL, Jensen A , Saag H, et al. Abstract 9207. Increased Mortality Associated with Resident Handoff in a Multi-Center Cohort. Presented May 18, 2016 at the American Thoracic Society Annual Meeting. San Francisco, California.