Highlights
- •Early handoff was independently associated with an increased length of stay.
- •Major complications were more frequent after early handoff.
- •Early handoff had no impact on use of resources.
Abstract
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
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Article info
Publication history
Published online: July 13, 2019
Accepted:
July 9,
2019
Received in revised form:
June 9,
2019
Received:
March 23,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.