Association of weekend continuity of care with hospital length of stay

Blecker, Saul; Shine, Daniel; Park, Naeun; Goldfeld, Keith; Braithwaite, R. Scott; Radford, Martha J.; Gourevitch, Marc N.

doi:10.1093/intqhc/mzu065

Cited by 38 publications

(37 citation statements)

References 43 publications

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“…Hadjistavropoulos et al (2008) stressed that CoC involves important quality of continuity and this is a patient-centred form of care that is dependent on interdisciplinary collaboration. To make it possible for patients to receive medical care that will facilitate improvement in their condition and help them obtain related health knowledge and self-care skills, well-planned hospitalisation care and follow-up care arrangements should be applied to help reduce the length of stay, improve bed usage, improve hospital service quality and further achieve cost control (Allen et al 2014, Blecker et al 2014, Fukuda et al 2015. The literature shows that the PCCQ can be used to understand the essential components of patient CoC based on the patients' experiences (Medina-Mirapeix et al 2011).…”

Section: Introductionmentioning

confidence: 99%

A Chinese version of the Patient Continuity of Care Questionnaire: reliability and validity assessment

Chen

2017

Journal of Clinical Nursing

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Section: Introductionmentioning

confidence: 99%

A Chinese version of the Patient Continuity of Care Questionnaire: reliability and validity assessment

Chen

2017

Journal of Clinical Nursing

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“…While attending physicians do not have official restrictions on shift length or frequency, recent studies on intensivist schedules show that frequent transitions in schedules help decrease physician burnout and could lead to decreased mortality, perhaps due to a “second set of eyes” mechanism . Unfortunately, only few studies have analysed attending or intensivist continuity of care, and it is unclear to what extent attending shift changes affect patient outcomes…”

Section: Discussionmentioning

confidence: 99%

“…Thus, many handoff improvement strategies have been developed to standardize processes that enhance patient satisfaction and clinical outcomes . However, only a handful have focused on handoff frequency, which evaluated handoff frequency for residents, nurses, and respiratory therapists, and even fewer studies have addressed attending handoffs …”

Section: Introductionmentioning

confidence: 99%

“…6 However, only a handful have focused on handoff frequency, which evaluated handoff frequency for residents, nurses, and respiratory therapists, and even fewer studies have addressed attending handoffs. [7][8][9][10] In the ICU, optimizing attending handoffs are especially important because attendings lead the team and are ultimately responsible for the patient. The attending physician shapes the development of patient care plans, offers prognoses, and guides the care team in making important decisions.…”

Section: Introductionmentioning

confidence: 99%

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The correlation between intensive care unit attending physician continuity of care with financial and clinical outcomes

Selvam

Furqan

York

et al. 2018

Evaluation Clinical Practice

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Purpose “Attending rotations” on intensive care unit (ICU) services have been in place in most teaching hospitals for decades. However, the ideal frequency of patient care handoffs is unknown. Frequent attending physician handoffs could result in delays in care and other complications, while too few handoffs can lead to provider burnout and exhaustion. Therefore, we sought to determine the correlation between frequency of attending shifts with ICU charges, 30‐day readmission rates, and mortality rates. Methods We performed a retrospective cohort study at a large, urban, academic community hospital in Baltimore, MD. We included patients admitted into the cardiac or medical ICUs between September 1, 2012, and December 10, 2015. We tracked the number of attending shifts for each patient and correlated shifts with financial outcomes as a primary measure. Results For any given ICU length of stay, we found no distinct association between handoff frequency and charges, 30‐day readmission rates, or mortality rates. Conclusions Despite frequent handoffs in care, there was no objective evidence of care compromise or differences in cost. Further validation of these observations in a larger cohort is justified.

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“…40 Discontinuity of care in any form contributes to medical complications and increased LOS, whether from handoffs, short versus long call period, or hospital stay encompassing a weekend. 9,29,39,45,46 In the surgical ICU, increased fragmentation of care through handoffs has been associated with higher rates of reintervention, ICU readmission, and complications. 10 Resident handoffs are largely unstructured, have significant deficiencies, and frequently fail to convey essential patient information.…”

Section: Impact Of Handoffsmentioning

confidence: 99%

Implications of transitioning to a resident night float system in neurosurgery: mortality, length of stay, and resident experience

Davis¹,

Kuhn²,

Agee³

et al. 2017

JNS

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OBJECTIVE Many neurosurgical training programs have moved from a 24-hour resident call system to a night float system, but the impact on outcomes is unclear. Here, the authors compare length of stay (LOS) for neurosurgical patients admitted before and after initiation of a night float system at a tertiary care training hospital. METHODS The neurosurgical residency at the University of Alabama at Birmingham transitioned from 24-hour call to a night float resident coverage system in July 2013. In this cohort study, all patients admitted to the neurosurgical service for 1 year before and 1 year after this transition were compared with respect to hospital and ICU LOSs, adjusted for potential confounders. RESULTS A total of 4619 patients were included. In the initial bivariate analysis, night float was associated with increased ICU LOS (p = 0.032) and no change in overall LOS (p = 0.65). However, coincident with the transition to a night float system was an increased frequency of resident service transitions, which were highly associated with hospital LOS (p < 0.01) and ICU LOS (p < 0.01). After adjusting for resident service transitions, initiation of the night float system was associated with decreased hospital LOS (p = 0.047) and no change in ICU LOS (p = 0.35). CONCLUSIONS This study suggests that a dedicated night float resident may improve night-to-night continuity of care and decrease hospital LOS, but caution must be exercised when initiation of night float results in increased resident service transitions.

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Association of weekend continuity of care with hospital length of stay

Abstract: Increased weekend continuity of care is associated with reduced length of stay. Improvement in weekend cross-coverage and patient handoffs may be useful to improve clinical outcomes.

Cited by 38 publications

References 43 publications

A Chinese version of the Patient Continuity of Care Questionnaire: reliability and validity assessment

A Chinese version of the Patient Continuity of Care Questionnaire: reliability and validity assessment

The correlation between intensive care unit attending physician continuity of care with financial and clinical outcomes

Implications of transitioning to a resident night float system in neurosurgery: mortality, length of stay, and resident experience

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