APM perspectivesImpact of Resident Workload and Handoff Training on Patient Outcomes
Section snippets
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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Cited by (20)
The association between physician staff numbers and mortality in English hospitals
2021, EClinicalMedicineCitation Excerpt :In the UK 43% of medical consultant posts advertised were not appointed to in 2018 reflecting supply deficiencies [2] and recent surveys of the UK middle grade doctor workforce suggest that their workload has become unsustainable at current staffing levels [3]. The quality of hospital care is influenced by the number of medical staff such as consultants in the UK and residents in the USA (4-6). Hospital doctors as a group influence mortality [7], however, data on the differential impact of junior, middle grade and senior doctor staffing are lacking.
The Physician Handoff and Its Role in Quality and Safety
2018, Quality and Safety in NeurosurgeryRestrictions on surgical resident shift length does not impact type of medical errors
2017, Journal of Surgical ResearchCitation Excerpt :The authors concluded that stricter supervision of trainees or more training for inexperienced surgeons was unlikely to address a significant proportion of technical errors. Many studies have examined principles of effective handoffs and influence on patient outcomes, which have become more important with decreased shift length.21-24 The assumption that surgeons have worse outcomes after operating the previous night has also been challenged.
Assessment and standardization of resident handoff practices: PACT project
2013, Journal of Surgical ResearchCitation Excerpt :A literature search by DeRienzo et al. showed that there were three overarching principles to an effective handoff: (1) the necessity of formal didactic training; (2) face-to-face, uninterrupted communication, with a combination of verbal and electronic transfer of patient information; and (3) clear and correct data [3]. Although reforms to resident duty hours were intended to improve patient outcomes by reducing fatigue, numerous authors have noted that the increased number of times patient care is transferred has potential for miscommunication, with resultant errors [8,9,12–18]. To compensate for the problematic addition of increased handoffs, exchange of patient information must be accurate and complete.
Intern workload and discontinuity of care on 30-day readmission
2013, American Journal of MedicineWho's covering our loved ones: Surprising barriers in the sign-out process
2013, American Journal of SurgeryCitation Excerpt :Although our impact on patient safety via the implementation of a set of sign-out guidelines appears to have been limited, other investigators have reported some success with interventions aimed to improve the handoff process. A recent study of a national sample of internal medicine residency-affiliated hospitals demonstrated that programs that train house staff in handoffs may have significantly better outcomes for pneumonia patients than those that do not.14 In another recent study, the implementation of a resident-designed template for patient handovers resulted in general surgery residents reporting decreased instances of prescribing and treatment errors.29
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.