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

Abstract

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. We examined the association between the number of patients seen by a teaching team, 30-day readmission, and 60-day mortality. 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. 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 5.3days; 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. 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.