title: Effect of resident handoffs on length of hospital and intensive care unit stay in a neurosurgical population: a cohort study.
abstract: OBJECT Handoffs and services changes are potentially modifiable sources of medical error and delays in transition of care. This cohort study assessed the relationship between resident service handoffs and length of stay for neurosurgical patients. METHODS All patients admitted to the University of Alabama at Birmingham neurosurgical service between July 1, 2012, and July 1, 2014, were retrospectively identified. A service handoff was defined as any point when a resident handed off coverage of a service for longer than 1 weekend. A conditional probability distribution was constructed to adjust length of stay for the increasing probability of a random handoff. The Student t-test and ANCOVA were used to assess relationships between resident service handoffs and length of hospital stay, adjusted for potential confounders. RESULTS A total of 3038 patients met eligibility criteria and were included in the statistical analyses. Adjusted length of hospital stay (5.32 vs 3.53 adjusted days) and length of ICU stay (4.38 vs 2.96 adjusted days) were both longer for patients who experienced a service handoff, with no difference in mortality. In the ANCOVA model, resident service handoff remained predictive of both length of hospital stay (p < 0.001) and length of ICU stay (p < 0.001). CONCLUSIONS Occurrence of a resident service handoff is an independent predictor of length of hospital and ICU stay in neurosurgical patients. This finding is novel in the neurosurgical literature. Future research might identify mechanisms for improving continuity of care and mitigating the effect of resident handoffs on patient outcomes.
authors.affiliation: Department of Neurosurgery and.
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Kuhn
authors.affiliation: Department of Neurosurgery and.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Davis
authors.affiliation: Department of Neurosurgery and.
authors.forename: Bonita S
authors.initials: BS
authors.lastname: Agee
authors.affiliation: Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Alabama.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Oster
authors.affiliation: Department of Neurosurgery and.
authors.forename: James M
authors.initials: JM
authors.lastname: Markert
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education*; D062209:Patient Handoff; D010359:Patient Readmission
keywords: ACGME = Accreditation Council for Graduate Medical Education; DRG = diagnosis-related group; FIRST = Flexibility In duty hour Requirements for Surgical Trainees; LOS = length of stay; length of stay; neurosurgery; patient handoff; patient outcome