Medical resident handoffs pose patient safety risk

A new study found that the risk of death at the hospital is higher when patients are transferred from one care team to another.

Evidence continues to mount that poorly handled handoffs from one medical resident to another pose major risks for patients.

A new study published in the Journal of the American Medical Association this week examined the impact that end-of-rotation resident transfers—when patients are transferred from one care team to another, potentially after weeks with the original clinicians—could have on patient outcomes, and found that the risk of death at the hospital is higher.

Researchers from the University of Colorado Anschutz Medical Campus examined data on more than 230,000 patients at 10 Department of Veterans Affairs hospitals, according to the study. They found an increase of between 1.5% and 1.9% in hospital  among hospitalized  exposed to end-of-rotation transitions in care between medical residents. This corresponded with 12% to 18% greater odds of death in the hospital for these patients.

In addition to higher death rates in the hospital, the study also found higher mortality rates among these patients long after they leave the hospital. Patients whose hospital stay involved an end-of-rotation transition in care between interns, residents, or a combination of the two had between 10% and 21% greater odds of dying at 30 or 90 days, according to the study announcement.

“That suggests that something is happening during this transition that we need to work on, focusing on the period when the residents actually leave,” said lead author Joshua Denson, M.D., a fellow in pulmonary and critical care at the University of Colorado School of Medicine, in the announcement. “It might be that patients are getting discharged more quickly than they should be once the transition occurs. The incoming resident might not have enough information to determine when patients are actually ready to be discharged or even worse, they might have the wrong information when they are discharged.”

In an accompanying editorial in JAMA, two physicians who reviewed the study note possible explanations for why those numbers may spike under certain types of clinicians. A patient may not receive enough attention from either the admitting team or the team that takes over after handoff, they write, or an intern-resident team may come in and take a “fresh look” at a patient who may not benefit from additional care interventions.

But in a piece for MedPage Today, F. Perry Wilson, M.D., questions the findings. He says several factors influence the study results. Sicker patients are more likely to die and more likely to have longer hospital stays. And the longer the stay, the more likely the patient will have a care transition. But clinicians also often wait until Monday to discharge patients, which again means patients will experience a handoff to another care team prior to discharge, he said.

Previous studies however have also identified handoffs as risky for patients. Research released earlier this year found that the level of a clinician’s training could play a role in mortality risk during handoff, and a 2015 study suggested that handoffs between the emergency department and inpatient admission may be a particular hospital weak link. Improving communication during handoff is key, and new apps and tools are hitting the market to help clinicians do so.