Call nights and patient care - Effects on inpatients at one teaching hospital

Objective:To determine whether the timing and number of patients admitted by internal medicine housestaff under a traditional call schedule affect the resource utilization and outcome of care for those patients. Design:Retrospective cohort study, using existing computerized records. Setting:University-affiliated 340-bed city/county teaching hospital. Patients/participants:22,112 patients discharged from the internal medicine service who had been admitted by an on-call first-year resident between January 1, 1980, and December 31, 1987. Measurements and main results:Admission after 5:00 PM was associated with decreased hospital length of stay (8.1%, p<0.0001), but increased total charges (3.1%, p=0.007). The relative risk of inpatient mortality for patients admitted at night was 1.21 (p=0.03). Patients of busier housestaff, as indicated by a larger number of on-call admissions, had lower total charges (1.7% decreased per admission) and no change in risk of inpatient mortality. While no linear relation was found between number of admissions and length of stay, analysis of nonlinear effects revealed that length of stay first rises, then falls as interns receive more on-call admissions. Conclusions:The number and timing of admissions by oncall internal medicine housestaff are significantly related to length of hospital stay, total charges, and likelihood of inpatient mortality at one teaching hospital. These variations should be considered in planning the reform of residency training programs.