title: Effect of surgery resident change of shift on trauma resuscitations and outcomes.
abstract: BACKGROUND
  The ability of surgery residents to provide continuity of care has come under scrutiny with work hour restrictions. The impact of the surgery resident sign-out period (6-8am and 6-8pm) on trauma outcomes remains unknown. We hypothesize that during shift change, resuscitation times are prolonged with worse outcomes.
  
  
  METHODS
  Records of patients treated at a university-based urban trauma center during 2008 and 2009 were reviewed. Patients were separated into a shift change group (6-8am and 6-8pm) and a control group of all other time periods and compared using ANOVA, chi square, and unpaired t-tests.
  
  
  RESULTS
  We reviewed the charts of 4361 consecutive trauma patients. There was no difference in gender, acuity, resuscitation times, Glasgow Coma Scale, revised trauma score, injury severity score (ISS), or probability of survival score between patients arriving during shift change compared to other times (p>0.2). There was no difference in total emergency department time for patients arriving during shift change (p = 0.07), even when stratified by ISS (ISS<15, p = 0.09; ISS>15, p = 0.2). Length of stay was increased for patients arriving during shift change compared to other times (5 vs 4 days, p<0.05). This was more pronounced for those with ISS>15 (16 vs 11 days, p = 0.03); however, there was no impact on intensive care unit length of stay, ventilator days, and mortality (p>0.3) regardless of ISS.
  
  
  CONCLUSIONS
  Trauma outcomes are generally unaffected by patient arrival during shift change when resident sign-outs occur. Although adaptations are being made to accommodate trauma patient arrival during these times, we need to continue paying close attention, especially to seriously injured patients, to ensure that there are no delays in care that may potentially affect patient outcomes.
authors: Department of Surgery, University of California San Francisco East Bay, Oakland, California 94602, USA. lyeung@acmedctr.org
authors: Louise
authors: L
authors: Yeung
authors: Emily
authors: E
authors: Miraflor
authors: Arturo
authors: A
authors: Garcia
authors: Gregory P
authors: GP
authors: Victorino
mesh_terms: D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling; D012151:Resuscitation; D014193:Trauma Centers; D015599:Trauma Severity Indices; D000078329:Workforce; D016526:Workload