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Hospitalist Continuity Doesn’t Affect Adverse Events among Inpatients


 

Hospitalist continuity does not appear to be associated with the incidence of adverse events (AEs), according to a new report in the Journal of Hospital Medicine.

Authors used two methods to measure continuity: the Number of Physicians Index (NPI) represented the total number of unique hospitalists caring for a patient, while the Usual Provider of Care (UPC) Index was the proportion of encounters with the most frequently encountered hospitalist.

Researchers reported that, in unadjusted models, each one-unit increase in the NPI—meaning less continuity—was significantly associated with the incidence of one or more AEs (odds ratio, 1.75; P<0.001). In addition, UPC was not associated with incidence of AEs. Across all adjusted models, neither index was "significantly associated" with the incidence of AEs.

Lead author Kevin O'Leary, MD, MS, SFHM, of Northwestern University's Feinberg School of Medicine in Chicago, says that the data could be used to help determine how best to structure handoffs.

"Where I think this has a major impact is that a whole lot of groups [are] trying to figure out how long should our rotation length be," Dr. O'Leary says. "All of those programs that are really trying to maximize continuity because they think it's the safest thing and best thing for patient outcomes, they can probably relax a little bit and swing the pendulum a little bit further toward what they think is the right model for the work-life balance of their hospitalist. [They can] worry a little bit less about the impact on the patients because there doesn't seem to be much." TH

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