APM perspectives
Impact of Resident Workload and Handoff Training on Patient Outcomes

https://doi.org/10.1016/j.amjmed.2011.09.005Get rights and content

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Overview

To assess whether variability in resident workload and training program management of transitions of care are associated with patient outcomes, we examined data from 3 nationally representative datasets: 2007 Hospital Quality Alliance (HQA) data,26 the 2008 Association of Program Directors of Internal Medicine (APDIM) survey,27 and 2008 American Hospital Association (AHA) data.28 Utilizing these data, we examined whether program director reporting of resident workload and handoff training and

Hospital Characteristics

Of the 373 internal medicine residency programs that were sent surveys, 268 (72%) responded with similar program characteristics between responders and nonresponders.27 Of these programs, 169 had available predictor and outcome data and were included in final analysis. The average reported mean maximum census was 10.5 patients and average mean maximum admits were 5.4 patients. One hundred nineteen (70%) reported that they trained their house staff in handoffs and 89 (53%) reported that they

Conclusions

In this nationally representative evaluation of internal medicine residency-affiliated primary hospitals, we found that resident workload had no significant association with quality of care and patient outcomes for the most common inpatient diagnoses. We did note that primary affiliated hospitals of internal medicine residency programs that train their residents in patient handoffs have lower 30-day risk-adjusted mortality rates for patients with pneumonia, controlling for hospital and program

Acknowledgements

We greatly acknowledge the efforts of the Mayo Clinic Survey Research Center for their assistance with design and data collection of the Association of Program Directors of Internal Medicine survey. This study was supported in part by the Mayo Clinic Internal Medicine Residency Office of Educational Innovations. Dr Mueller was also supported by an Institutional National Research Service Award #T32-HP10251 and by the Division of General Medicine at Brigham and Women’s Hospital.

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References (39)

  • K.E. Fletcher et al.

    Systematic review: effects of resident work hours on patient safety

    Ann Intern Med

    (2004)
  • D.L. Howard et al.

    Do regulations limiting residents” work hours affect patient mortality?

    J Gen Intern Med

    (2004)
  • L.I. Horwitz et al.

    Changes in outcomes for internal medicine inpatients after work-hour regulations

    Ann Intern Med

    (2007)
  • K.D. Shetty et al.

    Changes in hospital mortality associated with residency work-hour regulations

    Ann Intern Med

    (2007)
  • M.J. Press et al.

    The impact of resident duty hour reform on hospital readmission rates among medicare beneficiaries

    J Gen Intern Med

    (2011)
  • M. Ong et al.

    House staff team workload and organization effects on patient outcomes in an academic general internal medicine inpatient service

    Arch Intern Med

    (2007)
  • M.H. Coit et al.

    The effect of workload reduction on the quality of residents' discharge summaries

    J Gen Intern Med

    (2011)
  • A.R. Vidyarthi et al.

    Managing discontinuity in academic medical centers: strategies for a safe and effective resident sign-out

    J Hosp Med

    (2006)
  • L.I. Horwitz et al.

    Transfers of patient care between house staff on internal medicine wards: a national survey

    Arch Intern Med

    (2006)
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    Funding: None.

    Conflict of Interest: Dr LeRoi Hicks is on the Board of Directors of Health Resources in Action and a scientific advisor to the Health Management Corporation. All other authors declare that they have no conflicts of interest with regard to this manuscript.

    Authorship: This manuscript represents original work, and has been approved by all authors, each of whom contributed significantly to this manuscript.

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