Effects of end-of-month admission on length of stay and quality of care among inpatients with myocardial infarction

PURPOSE: We studied whether transfer of care when house staff and faculty switch services affects length of stay or quality of care among hospitalized patients. SUBJECTS AND METHODS: We performed a retrospective analysis in 976 consecutive patients admitted with myocardial infarction from 1995 to 1998. Patients who were admitted within 3 days of change in staff were denoted end-of-month patients. RESULTS: Of 782 eligible patients, 690 (88%) were admitted midmonth and 92 (12%) at the end of the month. The median length of stay was 7 days for midmonth and 8 days for end-of-month patients (P = 0.06). End-of-month admission was an independent predictor of length of stay in multivariate models. In addition, a significant difference in length of stay was noted between patients admitted at the beginning and end of the academic year. There were no statistically significant differences in the use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, or lipid-lowering agents at discharge between midmonth and end-of-month patients. Mortality and in-hospital adverse events did not differ between the two groups, with the possible exception of a greater incidence of acute renal failure in the end-of-month patients. CONCLUSION: Although admission during the last 3 days of the month is an independent predictor of length of stay, it does not have a large effect on quality of care among patients with myocardial infarction.