Increased Mortality Rates During Resident Handoff Periods and the Effect of ACGME Duty Hour Regulations - 31/08/15
, Matthew McCarty, MD b, Yixin Fang, PhD c, Amit Uppal, MD d, Laura Evans, MD, MSc dAbstract |
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) vs control group (discharged the 3 weeks of each 4-week rotation before resident service change). The primary outcome was unadjusted and adjusted hospital mortality rate. As a secondary prespecified analysis, we examined the effect of 2011 Accreditation Council for Graduate Medical Education (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 = .007; odds ratio [OR] 1.30; 95% confidence interval [CI], 1.08-1.57). Following adjustment, this association remained statistically significant (adjusted OR 1.34; P = .003; 95% CI, 1.10-1.62). Similarly, pre-duty-hour unadjusted hospital mortality was higher in the handoff group vs control group (2.87% vs 2.01%, respectively; P = .006; OR 1.44; 95% CI, 1.11-1.86), which remained statistically significant following adjustment (adjusted OR 1.50; P = .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 = .30; OR 1.16; 95% CI, 0.88-1.53) and adjusted mortality (OR 1.18; P = .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 toward higher mortality remained following resident handoff.
Le texte complet de cet article est disponible en PDF.Keywords : Duty hours, Handoff, Handover, Mortality, Resident duty-hour reform, Transitions of care
Plan
| Funding: No funding source had a role in the design or conduct of the study; data collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. |
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| Conflict of Interest: None of the authors have any conflict of interest to declare. |
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| Authorship: The authors had access to all the study data, take responsibility for the accuracy of the analysis, and had authority over manuscript preparation and the decision to submit the manuscript for publication. |
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| Study concept and design: JLD, LE, AU. |
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| Acquisition of data: LE. |
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| Analysis and interpretation of data: LE, JLD, YF. |
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| Drafting of the manuscript: JLD, LE, YF. |
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| Critical revision of the manuscript for important intellectual content: JLD, LE, AU, MM, YF. |
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| Statistical analysis: LE, YF. |
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| Administrative, technical, or material support: JLD, LE, AU, MM. |
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| Study supervision: JLD, LE. |
Vol 128 - N° 9
P. 994-1000 - septembre 2015 Retour au numéro
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