Hold-Over Admissions: Are They Educational for Residents?

• Published in: Journal of general internal medicine : JGIM Vol. 29; no. 3; pp. 463 - 467
• Main Authors: Bump, Gregory M., Zimmer, Shanta M., McNeil, Melissa A., Elnicki, D. Michael
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.03.2014; Springer; Springer Nature B.V
• Subjects: Adult; Biological and medical sciences; Curricula; Data Collection - methods; Female; General aspects; Health participants; Humans; Internal Medicine; Internal Medicine - education; Internal Medicine - methods; Internal Medicine - trends; Internship and Residency - methods; Internship and Residency - trends; Male; Medical residencies; Medical sciences; Medicine; Medicine & Public Health; Original Resarch; Patient Admission - trends; Patient admissions; Perceptions; Personnel Staffing and Scheduling - trends; Public health. Hygiene; Public health. Hygiene-occupational medicine; Time management; Work Schedule Tolerance; graduate medical education; hold-over; hand-off; night-float; transitions; Human; Night; Physician; Hand; Medicine; Education; Professional practice; Transition; Resident (student); Resident
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-013-2667-y

ABSTRACT PURPOSE Since implementation of resident duty-hour restrictions, many academic medical centers utilize night-float teams to admit patients during off hours. Patients are transferred to other resident physicians the subsequent morning as “hold-over admissions.” Despite the increase of hold-over admissions, there are limited data on resident perceptions of their educational value. This study investigated resident perceptions of hold-over admissions, and whether they approach hold-over admissions differently than new admissions. METHOD Survey of internal medicine residents at an academic medical center. RESULTS A total of 111 residents responded with a response rate of 71 %. Residents reported spending 56.2 min (standard deviation [SD] 18.9) compared to 80.0 min (SD 25.8) admitting new patients ( p  < 0.01). Residents reported spending significantly ( p  < 0.01) less time reviewing the medical record, performing histories, examining patients, devising care plans and writing orders in hold-over admissions compared to new admissions. Residents had neutral views on the educational value of hold-over admissions. Features that significantly ( p  < 0.01) increased the educational value of admissions included severe illness, patient complexity, and being able to write the initial patient care orders. Residents estimated 42.5 % (SD 14) of their admissions were hold-over patients. CONCLUSIONS Residents spend less time in all aspects of admitting hold-over patients. Despite less time spent admitting hold-over patients, residents had neutral views on the educational value of such admissions.