The Impact of the Number of Admissions to the Inpatient Medical Teaching Team on Patient Safety Outcomes

Abstract

INTRODUCTION: The clinical work in academic internal medicine inpatient units is done by teaching teams. To date, few studies have investigated how team workload affects patient safety outcomes. OBJECTIVE: We examined the association between the number of patients seen by a teaching team, 30-day readmission, and 60-day mortality. METHODS: In this retrospective observational study we defined each team as "less busy" (total monthly admissions ≤49, the median for all teams) or "more busy" (total monthly admissions >49). We compared patients in both groups' demographic characteristics, comorbidities (Charlson score), severity of illness (the Laboratory-based Acute Physiology Score [LAPS]), and length of stay using t tests, χ(2) tests, and rank sum tests, as appropriate. Logistic regression models were constructed to determine whether there was an association between assignment to a busy team and readmission and mortality. RESULTS: Of 12 119 admissions examined, 6398 (52.8%) were assigned to the less busy teams and 5721 (47.2%) were assigned to busy teams. Mean length of stay was not statistically different between the groups (5.2 vs 5.3 days; P = .08). After adjustment for demographic and clinical characteristics (LAPS and Charlson score), care by a busy team was associated with greater 30-day readmission rate (odds ratio, 1.21; 95% confidence interval [CI], 1.10-1.34) but not with increased risk of mortality (odds ratio, 1.05; 95% CI, 0.88-1.27). There was a significant linear association between the number of monthly admissions to teams and the readmission rate. CONCLUSIONS: Admission to a busier teaching team is associated with a 21% increase in the odds of 30-day readmission. Sixty-day mortality was not affected by the number of monthly admissions to the teaching team.