Use of hospitalists on overnight shift doesn't change patient outcomes

Historically, residents were on their own on the overnight shift in hospitals, making decisions about patient care. In recent years, many teaching hospitals have established an overnight academic hospitalist program--which puts a hospitalist physician in charge of supervising overnight medical residents--in response to concerns for patient safety and quality of care.

But a recent study found that in one such program at the Penn State Hershey Medical Center, having an on-site, attending-level physician provide overnight supervision did not make a difference in quality of care. The medical center did not see any significant impact on important clinical outcomes, according to study results published in the Journal of General Internal Medicine.

It is the first study to look at the impact of an overnight academic hospitalist program, according to a statement from Penn State. Researchers evaluated the impact of the overnight hospitalist program, implemented in September 2012, on five patient outcomes: in-hospital mortality rates, 30-day readmission rates, lengths of stay and transfers to the intensive care unit both on the night of admission or later in the hospital stay. They reviewed medical records for more than 6,000 patients admitted to the internal medicine department at the medical center on the overnight shift between April 2011 and May 2014.

Researchers found there were no significant differences between any of the outcomes when comparing patients admitted before and after the overnight hospitalist program was put in place. For instance, the in-hospital mortality rate was at 1.1 percent before the program was in place and at 0.9 percent after the hospitalist was supervising residents.

"Given that regulatory bodies are pushing toward on-site house staff supervision, the medical education community needs to think about how to continue to allow autonomy for residents," said researcher Jed Gonzalo, M.D., associate dean for health systems education and assistant professor of medicine and public health sciences at Penn State College of Medicine. However, he noted in the study announcement, that the research looked at only one model of an overnight hospitalist program at one hospital and more study is needed into the pros and cons of such programs.

To learn more:
- here's the study abstract
- read the study announcement