Intern Transitions of Care Curriculum Through Posthospital Home and Skilled Nursing Facility Visits.

Journal Article (Journal Article)

Background : Transitions of care pose significant risks for patients with complex medical histories. There are few experiential medical education curricula targeting this important aspect of care. Objective : We designed and tested an internal medicine transitions of care experience integrated into interns' ambulatory curriculum. Methods : The program included 1-hour group didactics, a posthospitalization discharge visit in pairs with a home care nurse (cohort 1: 2011-2012; cohort 2: 2012-2013), and a half-day small-group visit to a skilled nursing facility led by a faculty member in geriatrics (cohort 2 only). Both visits had structured debriefings by faculty in geriatrics. For cohort 1, a quantitative follow-up survey was administered 18 to 20 months after the experience. For cohort 2, reflections were analyzed. Results : Thirty-three of 42 second-year residents (79%) in cohort 1 who participated in didactics and a home visit completed the survey. Seventy-six percent (25 of 33) reported increased knowledge of interprofessional team members' roles and the discharge process for patients with complex medical histories. Seventy-nine percent (26 of 33) reported continued use of medication reconciliation at discharge, and 64% (21 of 33) reported the experience enhanced their ability to identify threats to transitions. Of cohort 2 interns, 88% (42 of 48) participated in the home visit and 69% (33 of 48) in the skilled nursing facility visit. Intern reflections revealed insights gained, incomprehensive discharge plans, posthospital health care teams, and patients' postdischarge experience. Conclusions : An experiential transitions of care curriculum is feasible and acceptable. Residents reported using the curriculum 18 to 20 months after exposure.

Full Text

Duke Authors

Cited Authors

  • Miller, RK; Keddem, S; Katz, S; Smith, Z; Whitehouse, CR; Goldstein, K; Hirschman, KB; Johnson, JC

Published Date

  • August 2018

Published In

Volume / Issue

  • 10 / 4

Start / End Page

  • 442 - 448

PubMed ID

  • 30154977

Pubmed Central ID

  • PMC6108372

Electronic International Standard Serial Number (EISSN)

  • 1949-8357

Digital Object Identifier (DOI)

  • 10.4300/JGME-17-00499.1

Language

  • eng

Conference Location

  • United States