Associations between early handoffs, length of stay and complications in internal medicine wards: A retrospective study - Fehlmann, C.; Louis Simonet, M.; Reny, J. L.; Stirnemann, J.; Blondon, K. (Eur J Intern Med, 2019)
BACKGROUND: In US healthcare system, handoffs are associated with an increase in medical error and in hospital length of stay. In non-US healthcare systems, this phenomenon has not been well studied. We studied the association between early handoffs (EH) in a non-US internal medicine ward with length of stay (LOS), use of resources, major complication (MC) and discharge to post-acute care (PAC) facility. METHODS: We conducted a retrospective cohort study on patients admitted to the general internal medicine division. Patients with EH (defined as a transfer of responsibility between primary teams within the first 72 h) were compared with patients without EH. The primary outcome was LOS in the general internal medicine division. Secondary outcomes were the use of resources, the incidence of MC (transfer to intensive care, to intermediate care or death) and discharge to a PAC facility. RESULTS: We included 11,869 patients, 38% of whom were in the EH group. Patients were 67.7+/-16.6 years old and 53% were males. EH was independently associated with an increase of LOS (+6.4% [95% CI, 3.5%-9.5%], P < .001) and with an increased rate of MC (OR 1.3 [95% CI, 1.1-1.7], P = .012). In our subgroup analysis, the association between early handoff and LOS and MC rate were not statistically significant when the admission occurred on public holidays and weekends. CONCLUSIONS: Among patients admitted in our general internal medicine division, early handoffs were associated with significantly higher length of stay and major complication rate, but not in patients admitted during week-ends.
Keywords: journalArticle; Aged; Aged, 80 and over; Cohort Studies; Female; Hospital Departments; Humans; Internal Medicine; Length of Stay/*statistics & numerical data; Length of stay; Male; Medical Errors/*statistics & numerical data; Middle Aged; Patient Handoff/*statistics & numerical data; Patient handoff; Patient safety; Quality of healthcare; Retrospective Studies; Time Factors