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The Impact of Resident Holdover Admissions on Length of Hospital Stay and Risk of Transfer to an Intensive Care Unit.

Publication ,  Journal Article
Ashana, DC; Chan, VK; Vangala, S; Bell, DS
Published in: J Patient Saf
December 1, 2021

OBJECTIVE: Implementation of residency duty hour standards has led to adoption of different staffing models, such as the "holdover" model, whereby nighttime teams admit patients and transfer their care to daytime teams who provide ongoing care. In contrast, nonholdover teams at our institution are responsible for both admitting patients and providing ongoing care. We sought to determine whether patients admitted by holdover teams experience worse outcomes than those admitted by nonholdover teams. METHODS: This is a retrospective cohort study of patients admitted to the internal medicine hospital service at a quaternary care hospital from July 2013 to June 2015. Primary outcomes included hospital length of stay (LOS) and transfer to an intensive care unit within 72 hours of admission. Secondary outcomes were any transfer to an intensive care unit, in-hospital mortality, discharge to home (versus discharge to postacute care facility), and readmission to the health system within 30 days of discharge. RESULTS: We analyzed 5518 encounters, 64% of which were admitted by a holdover team. Outcomes were similar between study groups, except the LOS, which was 5.5 hours longer for holdover encounters in unadjusted analyses (5.18 versus 4.95 days, P = 0.04) but not significantly different in adjusted analyses. The mean discharge time was 4:00 p.m. for both groups, whereas the mean admission times were 12:00 a.m. and 4:00 p.m. for holdover and nonholdover encounters, respectively. CONCLUSIONS: Holdover encounters at our institution were not associated with worse patient safety outcomes. A small increase in LOS may have been attributable to holdover patients having earlier admission and identical discharge times.

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Published In

J Patient Saf

DOI

EISSN

1549-8425

Publication Date

December 1, 2021

Volume

17

Issue

8

Start / End Page

e1855 / e1859

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Patient Discharge
  • Length of Stay
  • Intensive Care Units
  • Humans
  • Hospital Mortality
  • Health Policy & Services
  • 4203 Health services and systems
  • 1117 Public Health and Health Services
 

Citation

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Ashana, D. C., Chan, V. K., Vangala, S., & Bell, D. S. (2021). The Impact of Resident Holdover Admissions on Length of Hospital Stay and Risk of Transfer to an Intensive Care Unit. J Patient Saf, 17(8), e1855–e1859. https://doi.org/10.1097/PTS.0000000000000662
Ashana, Deepshikha Charan, Vincent K. Chan, Sitaram Vangala, and Douglas S. Bell. “The Impact of Resident Holdover Admissions on Length of Hospital Stay and Risk of Transfer to an Intensive Care Unit.J Patient Saf 17, no. 8 (December 1, 2021): e1855–59. https://doi.org/10.1097/PTS.0000000000000662.
Ashana DC, Chan VK, Vangala S, Bell DS. The Impact of Resident Holdover Admissions on Length of Hospital Stay and Risk of Transfer to an Intensive Care Unit. J Patient Saf. 2021 Dec 1;17(8):e1855–9.
Ashana, Deepshikha Charan, et al. “The Impact of Resident Holdover Admissions on Length of Hospital Stay and Risk of Transfer to an Intensive Care Unit.J Patient Saf, vol. 17, no. 8, Dec. 2021, pp. e1855–59. Pubmed, doi:10.1097/PTS.0000000000000662.
Ashana DC, Chan VK, Vangala S, Bell DS. The Impact of Resident Holdover Admissions on Length of Hospital Stay and Risk of Transfer to an Intensive Care Unit. J Patient Saf. 2021 Dec 1;17(8):e1855–e1859.

Published In

J Patient Saf

DOI

EISSN

1549-8425

Publication Date

December 1, 2021

Volume

17

Issue

8

Start / End Page

e1855 / e1859

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Patient Discharge
  • Length of Stay
  • Intensive Care Units
  • Humans
  • Hospital Mortality
  • Health Policy & Services
  • 4203 Health services and systems
  • 1117 Public Health and Health Services