Blogger: Erin Raci Wetherbee
About the blogger: Erin Raci Wetherbee, MD is a staff pulmonologist at the Minneapolis VA Medical Center and assistant professor of medicine at the University of Minnesota. Her primary interest is in medical education, with a focus on interprofessional education. Dr. Wetherbee serves as core faculty and coach for the University of Minnesota internal medicine residency program.
Citation: Denson JL, Jensen A, Saag HS, et al. Association between end-of-rotation resident transition in care and mortality among hospitalized patients. JAMA. 2016;316(21):2204-2213. doi:10.1001/jama.2016.17424
Why this paper?
It’s not often that a medical education study is published linking training system factors to patient mortality, but when it does it’s worth a look. That is the case with this article published earlier this month in JAMA’s “Medical Education” theme issue.
The authors conducted a large retrospective cohort study of 6 years of inpatient general and subspecialty medical admissions at 10 university-affiliated VA hospitals with exclusively resident teaching teams, totaling 230,701 hospital discharges.
The study found significantly higher 30 day and 90 day mortality among the group of patients discharged or deceased within 7 days following a house staff transition. In hospital mortality was higher for those patients following intern or intern + resident transition, but not resident only transition. When the transition cohort was alternatively defined as those admitted in the 2 days preceding transition and compared to those admitted 2 weeks later, no mortality difference was observed.
For me, this study raises many questions surrounding team transitions. Are lapses in communication occurring for those medically complicated patients with longer lengths of stay? Are seriously ill patients more likely to consider hospice care after team transitions bring them a fresh look or second opinion? I found the article thought provoking as much for the discordant findings in the two analyses as for the observed mortality risk, and I look forward to more discussion on the topic.
