Increased Mortality Rates during Resident Handoff Periods and the Effect of ACGME Duty Hour Regulations.

Link to article at PubMed

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

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]

Leave a Reply

Your email address will not be published.