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Critical Care |

Increased Mortality Rates During Resident Handoff Periods and the Effect of ACGME Duty Hour Regulation FREE TO VIEW

Joshua Denson, MD; Mathew McCarty, MD; Yixin Fang, PhD; Amit Uppal, MD; Laura Evans, MD
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Bellevue Hospital Center, New York University School of Medicine, Department of Internal Medicine, New York, NY


Chest. 2014;146(4_MeetingAbstracts):338A. doi:10.1378/chest.2058935
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Abstract

SESSION TITLE: Late-Breaking Abstracts

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 28, 2014 at 08:45 AM - 10:00 AM

PURPOSE: Many medical errors occur due to miscommunication surrounding transitions in care or “handoffs.” Mandated resident duty-hour restrictions have increased the total number of handoffs, yet data regarding the effect of these changes on patient-centered outcomes is lacking. We investigated mortality rates during periods of resident handoff and the effect of duty-hour rule implementation.

METHODS: We reviewed 24,739 adult discharges from medical services at a public, university-affiliated hospital in New York City from July 1, 2010 to June 30, 2012. The primary exposure of interest was hospital discharge during the 7 days following a change in resident physician team “handoff period.” The primary study outcome was unadjusted and adjusted mortality rate in “handoff periods” compared to “control periods” (the three weeks of each 4-week long rotation prior to resident transition of care). Sub-analysis examined the effect of 2011 ACGME duty-hour changes on mortality.

RESULTS: Over the 2-year study period, unadjusted all-cause hospital mortality during the handoff period was significantly higher than the control period (2.74% vs. 2.12%, respectively; p=0.004, OR 1.30 [95%CI 1.09-1.57]). This association persisted after adjustment for age, sex, length of stay, calendar month, and Elixhauser Comorbidity Index (adjusted OR 1.29, p=0.01, [95%CI 1.05-1.57]). On sub-analysis, pre-duty hour unadjusted mortality rate was significantly higher in the handoff period versus control period (2.91% vs. 2.05%, respectively; p=0.003, OR 1.44 [95%CI 1.13-1.84]) with a similar finding in the adjusted mortality rate (adjusted OR 1.42, p=0.01, [95%CI 1.08-1.86]). However, this association lost statistical significance following duty-hour revision with respect to both unadjusted mortality (2.57% vs. 2.19%, respectively; p=0.33, OR 1.15 [95%CI 0.87-1.52]) and adjusted mortality (OR 1.15, p=0.33, [95%CI 0.86-1.54]).

CONCLUSIONS: Over a two-year time period, resident handoff was significantly associated with an increase in both unadjusted and adjusted all-cause hospital mortality the week following resident transition in care. Although improved by the 2011 ACGME duty-hour amendments, there remains a trend towards higher mortality during times of resident handoff.

CLINICAL IMPLICATIONS: These findings demonstrate a potential patient-centered outcome measure not previously reported that may be affected by enactment of a structured handoff system.

DISCLOSURE: The following authors have nothing to disclose: Joshua Denson, Mathew McCarty, Yixin Fang, Amit Uppal, Laura Evans

No Product/Research Disclosure Information


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