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Cited by 665Hospital Admissions and OutcomesPatient Safety and Medication ErrorsClinical Reasoning and Diagnostic Skills

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Does Housestaff Discontinuity of Care Increase the Risk for Preventable Adverse Events?

Petersen, Laura A., Brennan, Troyen A., O'Neil, Anne C., Cook, E. Francis, Lee, Thomas H.·1994·Annals of Internal Medicine
DOI 10.7326/0003-4819-121-11-199412010-00008
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Abstract

OBJECTIVE: To study the relation between housestaff coverage schedules and the occurrence of preventable adverse events. DESIGN: Case-control study. SETTING: Urban teaching hospital. PATIENTS: All 3146 patients admitted to the medical service during a 4-month period. MEASUREMENTS: A previously tested confidential self-report system to identify adverse events, which were defined as unexpected complications of medical therapy that resulted in increased length of stay or disability at discharge. A panel of three board-certified internists confirmed events and evaluated preventability based on case summaries. Housestaff coverage was coded according to the day in the usual intern's schedule and to cross-coverage status. Cross-coverage was defined as care by a house officer who was not the patient's usual intern and not a member of the usual intern's patient care team. Coverage for an adverse event was assigned according to who was covering during the proximate cause of that event. Clinical data were collected for each patient and two matched controls. RESULTS: Of the 124 adverse events reported and confirmed, 54 (44%) were judged potentially preventable. In the univariate analysis, patients with potentially preventable adverse events were more likely than their controls to be covered by a physician from another team at the time of the event (26% compared with 12% [odds ratio, 3.5; P = 0.01]). In the multivariate analysis, three factors were significant independent correlates of potentially preventable adverse events; cross-coverage (odds ratio, 6.1; 95% CI, 1.4 to 26.7), Acute Physiology and Chronic Health Evaluation II score (odds ratio per point, 1.2; CI, 1.1 to 1.4), and history of gastrointestinal bleeding (odds ratio, 4.7; CI, 1.2 to 19.0). CONCLUSION: Potentially preventable adverse events were strongly associated with coverage by a physician from another team, which may reflect management by housestaff unfamiliar with the patient. The results emphasize the need for careful attention to the outcome of work-hour reforms for housestaff.

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Metadata

Authors
Petersen, L. A., Brennan, T. A., O'Neil, A. C., Cook, E. F., & Lee, T. H.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Petersen, Laura A.
ORCID
Petersen, Laura A.
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
1994-12-01
Volume
121
Issue
11
Pages
866-872
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-121-11-199412010-00008
OpenAlex
W2095329624
Cited by
665
References
0
Citations by year
2026: 6 · 2025: 5 · 2024: 16 · 2023: 6 · 2022: 8 · 2021: 8 · 2020: 19 · 2019: 18 · 2018: 24 · 2017: 19 · 2016: 17 · 2015: 28 · 2014: 34 · 2013: 33 · 2012: 34
FWCI
5.91
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords
house staff, continuity of care, preventable adverse events, physician work hours, medical interns, APACHE II score, gastrointestinal bleeding, patient safety, teaching hospitals
MeSH terms
Accident Prevention, Workforce, Adult, Aged, Boston, Continuity of Patient Care, Female, Hospital Bed Capacity, 500 and over, Hospitals, Teaching, Humans, Internship and Residency, Male, Middle Aged, Patient Care Team, Personnel Staffing and Scheduling, Statistics as Topic, Work Schedule Tolerance, Case-Control Studies, Outcome Assessment, Health Care, Risk Assessment

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