study examines need to keep hospitalist on overnight shift

For decades, one of the primary testing grounds for medical residents were the overnight shifts at the hospital. That’s because there were no attending physicians present, meaning they were forced to make decisions on their own, something experts said provided them with not just the necessary experience, but also confidence in their abilities.

This arrangement has recently changed, however, as many teaching hospitals here in the U.S. have implemented what they call overnight academic hospitalist (OAH) programs in order to address concerns about quality of care and overall patient safety.

What this essentially means is that a hospitalist — a physician who primarily manages the care of hospital patients — is there to oversee the medical residents and ensure there are no mistakes.

While the natural inclination might be to think such a program would be highly beneficial, a recently published study in the Journal of General Internal Medicine has found these OAH programs may actually be having very little impact on important clinical outcomes.

The study in question was performed by researchers at Penn State University, who sought to examine the efficacy of the OAH program in place at their own Penn State Hershey Medical Center since September 2012.

Here, they gathered the hospital records of over 6,000 patients who were admitted to the medical center’s internal medicine department during the overnight shift from April 2011 through May 2014. They then proceeded to examine the effect of the OAH program on five patient outcomes:

  • Mortality rates
  • Lengths of stay
  • 30-day readmission rates
  • ICU transfers on the night of admission
  • ICU transfers later on in the hospital stay

Somewhat shockingly, they found very little difference in terms of any of the patient outcomes either before or after implementation of the OAH program. Indeed, the mortality rate after the program was instituted was found to be 0.9 percent, while the mortality rate before the program was instituted was found to be 1.1 percent.

While the researchers did indicate more study on the issue was needed, they nevertheless argued the study should perhaps cause teaching hospitals to consider alternatives that more carefully balance the needs of patient care with the needs of residency autonomy.

What are your thoughts on this study? Would you be more comfortable as a patient knowing an OAH program is in place?

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