title: Hold-over admissions: are they educational for residents?
abstract: OBJECTIVE
  Since implementation of resident duty-hour restrictions, many academic medical centers utilize night-float teams to admit patients during off hours. Patients are transferred to other resident physicians the subsequent morning as "hold-over admissions." Despite the increase of hold-over admissions, there are limited data on resident perceptions of their educational value. This study investigated resident perceptions of hold-over admissions, and whether they approach hold-over admissions differently than new admissions.
  
  
  METHODS
  Survey of internal medicine residents at an academic medical center.
  
  
  RESULTS
  A total of 111 residents responded with a response rate of 71 %. Residents reported spending 56.2 min (standard deviation [SD] 18.9) compared to 80.0 min (SD 25.8) admitting new patients (p < 0.01). Residents reported spending significantly (p < 0.01) less time reviewing the medical record, performing histories, examining patients, devising care plans and writing orders in hold-over admissions compared to new admissions. Residents had neutral views on the educational value of hold-over admissions. Features that significantly (p < 0.01) increased the educational value of admissions included severe illness, patient complexity, and being able to write the initial patient care orders. Residents estimated 42.5 % (SD 14) of their admissions were hold-over patients.
  
  
  CONCLUSIONS
  Residents spend less time in all aspects of admitting hold-over patients. Despite less time spent admitting hold-over patients, residents had neutral views on the educational value of such admissions.
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, UPMC Montefiore, 9 South, 200 Lothrop Street, Pittsburgh, PA, 15213-2582, USA, bumpgm@upmc.edu.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Bump
authors.forename: Shanta M
authors.initials: SM
authors.lastname: Zimmer
authors.forename: Melissa A
authors.initials: MA
authors.lastname: McNeil
authors.forename: D Michael
authors.initials: DM
authors.lastname: Elnicki
mesh_terms: D000328:Adult; D003625:Data Collection / Q000379:methods; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000379:methods* / Q000639:trends; D007396:Internship and Residency / Q000379:methods* / Q000639:trends; D008297:Male; D010343:Patient Admission / Q000639:trends; D010561:Personnel Staffing and Scheduling / Q000639:trends; D014940:Work Schedule Tolerance