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Changes in personnel on the inpatient service, including residents and attending physicians, create uncertainty. Residents who are leaving the service rotation and handing off the patients to the next resident team generally prefer the service to be neat and tidy, to involve little for the next team to have to do immediately, and, perhaps most importantly, to be small. Accordingly, some teams will work especially hard to discharge patients before service change, even though certain patients cannot and should not be discharged because they are too sick, or have social or financial issues preventing safe discharge. Thus, patients remaining after a service change may differ in important ways from those who are able to be discharged.
Arora VM, Farnan JM. Inpatient Service Change: Safety or Selection? JAMA. 2016;316(21):2193–2194. doi:10.1001/jama.2016.16398
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