End-of-Rotation House Staff Changes Linked to Increased Patient Mortality

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Resident and intern service changes are associated with increased mortality among hospitalized patients, suggests a retrospective cohort study in JAMA.

Researchers studied 230,000 patient discharges from 10 university-affiliated Veterans Affairs hospitals between 2008 and 2014. Patients were allotted to the "transition" group if they were admitted before an end-of-rotation transition (resident or intern) and were discharged or died within 7 days post-transition. The control group included all other discharges.

The primary outcome — in-hospital mortality — was significantly greater for intern-only transitions than controls (3.5% vs. 2.0%), and for intern-plus-resident transitions than controls (4.0% vs. 2.1%); resident-only transitions were not associated with in-hospital mortality. In addition, 30- and 90-day mortality rates were significantly higher for all types of transitions relative to controls. In an alternative analysis that looked at comparable patient populations, there was no significant difference in patients admitted before transition and control patients admitted in the middle of the rotation.

The authors say, "These results showed that end-of-rotation transitions in care were associated with increased mortality; however, this increased risk may be limited to longer stay, complex patients with greater comorbidities or those discharged soon after the transition."