Increased Mortality Rates during Resident Handoff Periods and the Effect of ACGME Duty Hour Regulations.
Am J Med. 2015 Apr 8;
Authors: Denson JL, McCarty M, Fang Y, Uppal A, Evans L
Abstract
BACKGROUND: Medical errors occur following handoff related miscommunication. Data regarding the effect on patient-centered outcomes, specifically mortality, are lacking. Our objective was to investigate handoff related mortality and the effect of duty-hour regulations.
METHODS: Retrospective cohort study of adult medical patients at a public, university-affiliated hospital from 2010 to 2012. Patients were divided into 2 cohorts: handoff group (discharged within 7 days following a change in resident physician team) versus control group (discharged the 3 weeks of each 4-week rotation prior to resident service change). The primary outcome was unadjusted and adjusted hospital mortality rate. As a secondary pre-specified analysis, we examined the effect of 2011 ACGME duty-hour changes.
RESULTS: Among 23,736 patients, unadjusted hospital mortality during the handoff group was higher than the control group (2.68% vs. 2.08%, respectively; p=0.007, OR 1.30 [95% CI 1.08-1.57]). Following adjustment, this association remained statistically significant (adjusted OR 1.34 p=0.003 [95% CI 1.10-1.62]). Similarly, pre-duty hour unadjusted hospital mortality was higher in the handoff group versus control group (2.87% vs. 2.01%, respectively; p=0.006, OR 1.44 [95% CI 1.11-1.86]), which remained statistically significant following adjustment (adjusted OR 1.50, p=0.002 [95% CI 1.16-1.95]). However, this association lost statistical significance following duty-hour revision with respect to both unadjusted (2.48% vs. 2.15%, respectively; p=0.30, OR 1.16 [95% CI 0.88-1.53]) and adjusted mortality (OR 1.18 p=0.26, [95% CI 0.89-1.56]).
CONCLUSIONS: Resident transition in care was significantly associated with an increase in unadjusted and adjusted hospital mortality. Although improved by 2011 ACGME duty-hour amendments, a trend towards higher mortality remained following resident handoff.
PMID: 25863148 [PubMed - as supplied by publisher]