End-of-rotation transitions among care teams can increase risk of patient death, study finds

End-of-rotation transition between resident care teams was associated with a significantly higher risk of in-hospital patient mortality, according to a study published in JAMA.

Researchers investigated 230,701 patients admitted to internal medicine services in 10 Veterans Affairs hospitals. They divided patients admitted prior to an end-of-rotation transition who died or who were discharged within seven days after transition into different groups — intern only, resident only or intern plus resident. They compared these groups with all other discharges, grouped together as the control component.

Here are six findings:

1. Among the cases examined, 25,938 intern-only, 26,456 resident-only and 11,517 intern plus resident end-of-rotation transitions occurred.

2. Overall mortality was 2.18 percent in-hospital, 9.45 percent at 30 days and 14.43 percent at 90 days.

3. Adjusted hospital mortality was significantly higher in the intern-only group and intern plus resident group as compared to the control group. The resident-only group did not see a higher mortality rate compared to the control group.

4. Adjusted 30-day and 90-day mortality rates were greater for all transition groups versus the control group.

5. Duty hour changes were associated with greater adjusted hospital mortality for transition patients in the intern-only group and intern plus resident group as compared to the control group.

6. An alternative restricted analyses did not show any significant differences in mortality between transition and control groups, however.

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