Richard P. Ramonell, MD, Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Denson JL et al. JAMA 2016 Dec 6. Arora VM and Farnan JM. JAMA 2016 Dec 6.

A retrospective cohort study suggests that end-of-rotation intern transitions portend excess patient mortality.

Transitions of patient care, including handoffs, are associated with adverse patient outcomes, but scant evidence has been collected on the relation between end-of-rotation resident transitions and patient outcomes (Acad Med 2009; 84:1775). In a retrospective cohort study, researchers examined data from >230,000 patients at 10 university-associated Veterans Affairs hospitals in which interns (first-year residents) and upper-level residents managed patients under attending-physician supervision. Patients who were admitted just prior to an end-of-rotation resident transition and were discharged or died within 7 days following that transition (transition group) were compared with all other discharged patients (control group).

In analyses adjusted for baseline differences in patient characteristics (including comorbidities), inpatient mortality was significantly higher for patients in the transition group when only interns were involved (3.5% vs. 2.0% in the control group) or when interns and upper-level residents were involved (4.0% vs. 2.1%) but not when only upper-level residents were involved (3.3% vs. 2.0%). Adjusted 30-day and 90-day mortalities were significantly higher in transitioned patients, regardless of resident level of training.

CITATION(S):

Denson JL et al. Association between end-of-rotation resident transition in care and mortality among hospitalized patients. JAMA 2016 Dec 6; 316:2204.

Arora VM and Farnan JM.Inpatient service change: Safety or selection? JAMA 2016 Dec 6; 316:2193. 

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