MedEdPORTAL (May 2014)
Safety First! Transitions From Hospital to Post-Acute Care
Abstract
Abstract Introduction With the advent of resident duty hour restrictions and the expanding hospitalist movement, there is potential for care fragmentation and communication break-down. The time for ensuring patient safety and maximizing health outcomes is at critical transitions of care, defined as the movement of patients from one practice setting to another. This curriculum was designed to provide this experiential learning and is based upon previous educational initiatives that required home visits for learners following a hospital discharge. The specific aim of this resource is to improve education on transitions of care between the hospital and a skilled nursing setting by enhancing the post-acute care clinical exposure through an interactive orientation session. Methods The session takes place 1 week prior to the start of the first rotation to ensure attendance by all. It is a required part of the orientation. Following an introduction and tour, interns meet and are paired to complete a scavenger hunt. During this activity interns find two different members of the interprofessional team and conduct an interview. The interns then share the interview answers in a small-group session. Chart reviews are then conducted to evaluate the completeness and usefulness of discharge paperwork from the receiving physician's perspective. The session ends with a wrap up, survey completion, and distribution of pocket cards and other resources. Results The workshop was evaluated using a retrospective pre-post quantitative questionnaire (5-point Likert scale ranging from “Unable to complete the [discharge] process” to “Can complete independently with no mentoring,” and three open-ended qualitative evaluation questions. Data was collected from years two and three of administration. Eighty-four percent of the incoming interns in year two (N = 31) indicated that they had never received formal instruction preworkshop and 81% (p = .0001, CI = −1.29 to −0.71) rated an improved ability to appropriately complete the discharge postworkshop. In year three (N = 36), 70% indicated never having received formal training and 72% (p = 0.0001, CI = −1.16 to −0.67) rated an improved ability to complete the discharge process postworkshop. Discussion Lack of health care provider education serves as a barrier to safe transitions of care because of the high potential for medical errors that occur with frequent transfers and hurried discharges. Since a successful hospital discharge is a complex and multifaceted clinical procedure, we facilitated hands-on learning through an interactive workshop, which we felt would be more effective than through the traditional lecture format.
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