Patient Mortality Up With End-of-Rotation Team Transition

Adherence to national recommendations regarding ideal rotation policies ranged from 6 to 67 percent

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TUESDAY, Dec. 6, 2016 (HealthDay News) -- Hospitalized patients who are handed off by their original medical team to a new set of caregivers may ultimately face a higher risk of early mortality, according to research published in the Dec. 6 issue of the Journal of the American Medical Association, a theme issue on medical education.

Researchers looked at the experiences of 230,701 patients being cared for at one of 10 U.S. Veterans Health Administration hospitals between 2008 and 2014. Most (95.8 percent) were men, average age 65.6, and the median hospital stay was just three days. Just over 2 percent of the patients died in hospital (2.18 percent), while 9.45 and 14.43 percent died within a month or three months after discharge, respectively.

Overall, the risk of dying both while in hospital or soon after discharge (at 30 and 90 days out) was significantly greater among those patients who underwent an end-of-rotation transfer while hospitalized, compared with those who didn't. Elevated risk only went up significantly among transfers handled either by interns alone, or by an intern/resident team. Apart from training status, the apparent rise in mortality risk held up across age, gender, race, ethnicity, or length of hospital stay.

In a second study in the same journal, Charlie Wray, D.O., from the San Francisco Veterans Affairs Medical Center, and colleagues examined routine adherence to national recommendations regarding ideal rotation policies, such as providing a dedicated time and place for patient hand-offs and/or ensuring hand-off supervision by senior physicians. The responses varied widely, with adherence ranging from just 6 percent in some cases to 67 percent in others, depending on the particular recommendation in question.

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