Analysis of Resident and Attending Physician End-of-Rotation Changeover Days and Association With Patient Length of Stay

Key PointsQuestionDo patients exposed to resident changeover have longer hospital stays, and does separating resident and attending physician changeover days modify this association? FindingsIn this cohort study of 95282 patients, exposure to end-of-rotation resident changeover was associated with an increase of 0.2 days in patients' length of hospital stay and with a decreased likelihood of discharge on the day of changeover. These associations were not modified when the resident changeover days were separated from attending physician changeover days. MeaningIn this study, resident changeover was associated with marginally longer patient hospital stay that was not affected by separating changeover days for resident and attending physicians. This cohort study examines whether patients exposed to end-of-rotation resident changeover have longer hospital stays and whether this association is mitigated by separating resident and attending changeover days. ImportanceEnd-of-rotation resident physician changeover is a key part of postgraduate training but could lead to discontinuity in patient care. ObjectiveTo test whether patients exposed to end-of-rotation resident changeover have longer hospital stays and whether this association is mitigated by separating resident and attending changeover days. Design, Setting, and ParticipantsThis retrospective cohort analysis included adult patients admitted to general internal medicine. The changeover day was the same day (first Monday of month) for both resident and attending physicians until June 30, 2013 (preseparation period), and then intentionally staggered by 1 or more days after July 1, 2013 (postseparation period). This was a multicenter analysis at 4 teaching hospitals in Ontario, Canada, from July 1, 2010, to June 30, 2019. Data analysis was conducted from July 2022 to January 2023. ExposuresPatients were classified as changeover patients if the first Monday was a resident changeover day and as control patients if the first Monday was not a resident changeover day. Main Outcomes and MeasuresThe primary outcome was length of hospital stay. Secondary outcomes were transfer to critical care, in-hospital death, and rate of discharge per 100 patients on the index day. ResultsOf 95282 patients. 22773 (24%; mean [SD] age, 67.8 [18.8] years; 11156 [49%] female patients) were exposed to resident changeover, and 72509 (76%; mean [SD] age, 67.8 [18.7] years; 35293 [49%] female patients) were not exposed to resident changeover. Exposure to resident changeover day was associated with a slightly longer hospital stay compared with control days (0.20 [95% CI, 0.09-0.30] days; P<.001) and decreased relative risk of patient discharge on the index day (relative risk, 0.92; 95% CI, 0.86-1.00; P=.047). These associations were similar in the preseparation and postseparation periods. Resident changeover was not associated with an increased risk of transfer to critical care or in-hospital death. Conclusions and RelevanceIn this study, a small positive association between exposure to resident physician changeover and length of hospital stay as well as reduced rate of discharge was found. These findings suggest that separating changeover days for resident and attending physicians may not significantly change these associations.