Redistribution of staff across shifts may increase readmissions

Changes in staff scheduling may increase hospital readmission rates, according to a study published in The American Journal of Medicine.

Researchers, led by Donald A. Redelmeier, M.D., of the University of Toronto's Department of Medicine, analyzed readmission rates at Toronto's Sunnybrook Health Sciences Center, a large teaching hospital, between January 2004 and December 2013. In 2009, the hospital overhauled its approach to organizing physician teams, which until that point had remained together throughout the shift. Under the new plan, senior and junior residents were distributed across four shifts.

The new distribution system meant patients could have a team member present every day, which, in theory, would improve continuity of care and decrease patient readmissions.

However, after the change, Redelmeier and his team identified a 30 percent increase in readmissions. The increase persisted across the board regardless of patient age, risk or other diagnoses and represented the equivalent of 7,240 additional patient days. Mortality rates remained the same.

"Together, the findings show that well-intentioned and well-received changes aimed at improving physician call systems can have unintended, undesirable and unrecognized consequences," Redelmeier wrote in the study. The researchers noted the results do not prove the call system should be done away with, but rather suggest the revisions to the scheduling system "creates a different balance of sustainability with continuity and merits more reconsideration for improvement."

In the quest to reduce readmission rates, hospitals are looking at less obvious potential causes beyond care quality, such as miscommunication among patients and hospital departments, emergency surgeries and socioeconomic factors such as patient employment status. The study results are likely to further fuel theories that lack of continuity of care is a major driver of preventable readmissions.

To learn more:
- here's the study abstract