Post-call transfer of resident responsibility
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Objective:To determine whether transferring the care of patients to another senior resident the day after admission to the bospital adversely affects the efficiency and quality of care.
Design:Retrospective analysis of a natural experiment.
Setting:The general medical service of the Minneapolis Veterans Affairs Medical Center, a major tertiary teaching hospital of the University of Minnesota internal medicine residency program.
Patients/participants:Subjects were all the patients admitted to the medicine service from 5:00 PM to 6:00 AM over an eight-month period.
Intervention:After 5:00 PM, half of the patients were admitted to the hospital by a cross-covering senior resident (CC group of patients), and their care was transferred to a different senior resident the following day. The other patients were initially evaluated by the primary senior resident (PE group of patients). Assignment to the different services was a random, sequential process.
Measurements and main results:The CC group had significantly more laboratory tests performed during their hospital stay than did the PE group of patients (44 vs. 32, p=0.01), even when adjusted for length of stay. Using multiple linear regression to adjust for other clinical parameters including length of stay, DRG weight, and number of consults, the authors found that being a CC subject was a significant predictor of the number of laboratory tests obtained (p=0.01). Furthermore, the median length of stay in the CC group (n=74) was longer than that in the PE group (n=72) (eight days vs. six days); this was of borderline statistical significance, using a two-sample median test (p=0.06).
Conclusion:Patients transferred to a different resident the day after admission had more laboratory tests performed and longer inpatient stays.
Key wordscontinuity of care resident education use of bospital resources laboratory testing cost of care transfer of care
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