Year-End Changeovers Linked to Decreased Quality of Care

Mortality and efficiency of care tend to worsen during trainee academic year-end changeovers

TUESDAY, July 12 (HealthDay News) -- Quality of health care tends to decrease at the time of academic year-end changeovers, with an increase in patient mortality and decrease in efficiency, according to a meta-analysis published online July 11 in the Annals of Internal Medicine.

John Q. Young, M.D., M.P.P., from the University of California School of Medicine in San Francisco, and colleagues reviewed available literature published between 1989 and 2010 to assess the impact of trainee changeover on patient outcomes. A total of 39 studies, most of which were conducted in the United States and which used a control group or time period as a comparator, were included, with 33 percent of these being of higher quality. The major outcomes reported included mortality (27 studies), morbidity (23 studies), efficiency (19 studies), and medical errors (six studies), with all studies focusing on inpatient settings.

The investigators found that there was an association between increased patient mortality and lower efficiency during the changeover period, which was demonstrated more often in studies with higher-quality designs and larger sample sizes. Morbidity and medical error outcomes were examined in studies that were of lower quality and produced varying results.

"Mortality increases and efficiency decreases in hospitals because of year-end changeovers, although heterogeneity in the existing literature does not permit firm conclusions about the degree of risk posed, how changeover affects morbidity and safety, or whether particular models are more or less problematic," the authors write.

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