Inpatient Housestaff Discontinuity of Care and Patient Adverse Events

Fletcher, Kathlyn E.; Singh, Siddhartha; Schapira, Marilyn M.; Ratkalkar, Vishal; Visotcky, Alexis; Laud, Purushottam W.; Kallio, Christa; Framberg, Susan; Li, Jianing; Kordus, Andrew; Whittle, Jeff

doi:10.1016/j.amjmed.2015.11.008

Cited by 4 publications

(2 citation statements)

References 39 publications

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“…Further work in the form of randomized, site-controlled studies are currently underway to understand the relationship between resident work hours and patient outcomes, however retrospective analysis of electronic health record data can offer a complementary method for rapid, cost-effective, and objective review of true resident work hours not biased by recall bias or the Hawthorne effect 10,11 . Working additional hours or carrying high patient censuses more frequently or for longer periods of time may lead to increased resident burn-out, decreased well-being, and decreased efficiency that are only exhibited after prolonged periods.…”

Section: Discussionmentioning

confidence: 99%

“…Rather, these studies primarily examined differences in patient outcomes based on changes in resident team structures and schedules implemented to adhere to ACGME duty hour standards. A recent study at an internal medicine program also did not show any increase in adverse events with discontinuity of care (10). Large randomized studies of surgical training programs have not shown any significant difference in patient care or trainee well-being, while a similar trial involving internal medicine programs is still underway (11–12).…”

Section: Introductionmentioning

confidence: 97%

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Patient Outcomes when Housestaff Exceed 80 Hours per Week

Ouyang

Chen

Krishnan

et al. 2016

The American Journal of Medicine

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Purpose It has been posited that high workload and long work hours for trainees could affect the quality and efficiency of patient care. Duty hour restrictions seek to balance patient care and resident education by limiting resident work hours. Through a retrospective cohort study, we investigate whether patient care on an inpatient general medicine service at a large academic medical center is impacted when housestaff work greater than eighty hours per week Methods We identified all admissions to a housestaff-run general medicine service between June 25, 2013 and June 29, 2014. Each hospitalization was classified by whether or not the patient was admitted by housestaff who have worked more than eighty hours a week during their hospitalization. Housestaff computer activity and duty hours were calculated by institutional electronic heath record audit, as well as length of stay and a composite of in-hospital mortality, ICU transfer rate, and 30-day readmission rate. Results We identified 4,767 hospitalizations by 3,450 unique patients; of which 40.9% of hospitalizations were managed by housestaff who worked more than eighty hours that week during their hospitalization. There was a significantly higher rate of the composite outcome (19.2% vs. 16.7%, p = 0.031) for patients admitted by housestaff working more than eighty hours a week during their hospitalization. We found a statistically significant higher length of stay (5.12 vs. 4.66 days, p = 0.048) and rate of ICU transfer (3.18% vs. 2.38%, p = 0.029). There was no statistically significant difference in 30-day readmission rate (13.7% vs. 12.8%, p = 0.395), or in-hospital mortality rate (3.18% vs. 2.42%, p = 0.115).There was no correlation with team census on admission and patient outcomes. Conclusions Patients taken care of by housestaff working more than eighty hours a week had increased length of stay and number of ICU transfers. There was no association between resident work-hours and patient in-hospital mortality or 30-day readmission rate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%