Discharge Communication: A Multi-Institutional Survey of Internal Medicine Residents' Education and Practices.
Clinical Competence
/ statistics & numerical data
Communication
Cross-Sectional Studies
Education, Medical, Graduate
/ methods
Educational Status
Humans
Internal Medicine
/ education
Internship and Residency
/ statistics & numerical data
Logistic Models
Patient Discharge
Patient Transfer
/ methods
Problem-Based Learning
/ statistics & numerical data
Surveys and Questionnaires
Teaching Rounds
/ methods
Journal
Academic medicine : journal of the Association of American Medical Colleges
ISSN: 1938-808X
Titre abrégé: Acad Med
Pays: United States
ID NLM: 8904605
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
pubmed:
18
12
2020
medline:
20
8
2021
entrez:
17
12
2020
Statut:
ppublish
Résumé
To characterize residents' practices around hospital discharge communication and their exposure to transitions-of-care instruction in graduate medical education (GME). In 2019, internal medicine residents at 7 academic medical centers completed a cross-sectional survey reporting the types of transitions-of-care instruction they experienced during GME training and the frequency with which they performed 6 key discharge communication practices. The authors calculated a mean discharge communication score for each resident, and, using multiple logistic regression, they analyzed the relationship between exposure to types of educational experiences and discharge communication practices residents reported they performed frequently (> 60% of time). The authors used content analysis to explore factors that motivated residents to change their discharge practices. The response rate was 63.5% (613/966). Resident discharge communication practices varied. Notably, only 17.0% (n = 104) reported routinely asking patients to "teach-back" or explain their understanding of the discharge plans. The odds of frequently performing key discharge communication practices were greater if residents received instruction based on observation of and feedback regarding their communication (adjusted odds ratio 1.73; 95% confidence interval [CI], 1.07-2.81) or if they received explicit on-rounds teaching (adjusted OR 1.46; 95% CI, 1.04-2.23). In open-ended comments, residents reported that experiencing adverse patient events at some point in the postdischarge continuum was a major impetus for practice change. This study exposes gaps in hospital discharge communication with patients, highlights the benefits of workplace-based instruction on discharge communication skills, and reveals the influence of adverse events as a source of hidden curricula. The results suggest that developing faculty to incorporate transitions-of-care instruction in their rounds teaching and integrating experiences across the postdischarge continuum into residents' education may foster physicians-in-training who are champions of effective transitions of care within the fragmented health care system.
Identifiants
pubmed: 33332907
doi: 10.1097/ACM.0000000000003896
pii: 00001888-202107000-00052
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1043-1049Informations de copyright
Copyright © 2020 by the Association of American Medical Colleges.
Références
Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–167.
Auerbach AD, Kripalani S, Vasilevskis EE, et al. Preventability and causes of readmissions in a national cohort of general medicine patients. JAMA Intern Med. 2016;176:484–493.
Antony SM, Grau LE, Brienza RS. Qualitative study of perspectives concerning recent rehospitalisations among a high-risk cohort of veteran patients in Connecticut, USA. BMJ Open. 2018;8:e018200.
Hesselink G, Flink M, Olsson M, et al.; European HANDOVER Research Collaborative. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. BMJ Qual Saf. 2012;21suppl 1i39–i49.
Howard-Anderson J, Busuttil A, Lonowski S, Vangala S, Afsar-Manesh N. From discharge to readmission: Understanding the process from the patient perspective. J Hosp Med. 2016;11:407–412.
Society of Hospital Medicine. Improving Hospital Outcomes Through Patient Engagement: The i-HOPE Study. https://www.hospitalmedicine.org/clinical-topics/i-hope-study . Accessed December 3, 2020.
Chan B, Englander H, Kent K, et al. Transitioning toward competency: A resident-faculty collaborative approach to developing a transitions of care EPA in an internal medicine residency program. J Grad Med Educ. 2014;6:760–764.
Buchanan IM, Besdine RW. A systematic review of curricular interventions teaching transitional care to physicians-in-training and physicians. Acad Med. 2011;86:628–639.
McBryde M, Vandiver JW, Onysko M. Transitions of care in medical education: A compilation of effective teaching methods. Fam Med. 2016;48:265–272.
Artino AR Jr, La Rochelle JS, Dezee KJ, Gehlbach H. Developing questionnaires for educational research: AMEE guide no. 87. Med Teach. 2014;36:463–474.
Snow V, Beck D, Budnitz T, et al.; American College of Physicians; Society of General Internal Medicine; Society of Hospital Medicine; American Geriatrics Society; American College of Emergency Physicians; Society of Academic Emergency Medicine. Transitions of care consensus policy statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine. J Gen Intern Med. 2009;24:971–976.
Burke RE, Kripalani S, Vasilevskis EE, Schnipper JL. Moving beyond readmission penalties: Creating an ideal process to improve transitional care. J Hosp Med. 2013;8:102–109.
Hansen LO, Greenwald JL, Budnitz T, et al. Project BOOST: Effectiveness of a multihospital effort to reduce rehospitalization. J Hosp Med. 2013;8:421–427.
Mitchell SE, Gardiner PM, Sadikova E, et al. Patient activation and 30-day post-discharge hospital utilization. J Gen Intern Med. 2014;29:349–355.
Yam CH, Wong EL, Cheung AW, Chan FW, Wong FY, Yeoh EK. Framework and components for effective discharge planning system: A Delphi methodology. BMC Health Serv Res. 2012;12:396.
Hohmann C, Neumann-Haefelin T, Klotz JM, Freidank A, Radziwill R. Adherence to hospital discharge medication in patients with ischemic stroke: A prospective, interventional 2-phase study. Stroke. 2013;44:522–524.
Daliri S, Bekker CL, Buurman BM, Scholte Op Reimer WJM, van den Bemt BJF, Karapinar-Carkit F. Barriers and facilitators with medication use during the transition from hospital to home: A qualitative study among patients. BMC Health Serv Res. 2019;19:204.
Balaban RB, Weissman JS, Samuel PA, Woolhandler S. Redefining and redesigning hospital discharge to enhance patient care: A randomized controlled study. J Gen Intern Med. 2008;23:1228–1233.
Burke RE, Guo R, Prochazka AV, Misky GJ. Identifying keys to success in reducing readmissions using the ideal transitions in care framework. BMC Health Serv Res. 2014;14:423.
Holland DE, Mistiaen P, Bowles KH. Problems and unmet needs of patients discharged “home to self-care.” Prof Case Manag. 2011;16:240–250.
Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: Results of a randomized controlled trial. Arch Intern Med. 2006;166:1822–1828.
Cain CH, Neuwirth E, Bellows J, Zuber C, Green J. Patient experiences of transitioning from hospital to home: An ethnographic quality improvement project. J Hosp Med. 2012;7:382–387.
White M, Garbez R, Carroll M, Brinker E, Howie-Esquivel J. Is “teach-back” associated with knowledge retention and hospital readmission in hospitalized heart failure patients? J Cardiovasc Nurs. 2013;28:137–146.
Oh EG, Lee HJ, Yang YL, Kim YM. Effectiveness of discharge education with the teach-back method on 30-day readmission: A systematic review. J Patient Saf. 2021;17:305–310.
Young E, Stickrath C, McNulty M, et al. Residents’ exposure to educational experiences in facilitating hospital discharges. J Grad Med Educ. 2017;9:184–189.
Suddarth KH, Jones RR, O’Malley CW, et al. Implementation of milestones-based assessment for a safe and effective discharge. Am J Med. 2016;129:640–646.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–1288.
Hong YR, Cardel M, Suk R, et al. Teach-back experience and hospitalization risk among patients with ambulatory care sensitive conditions: A matched cohort study. J Gen Intern Med. 2019;34:2176–2184.
Greysen SR, Schiliro D, Curry L, Bradley EH, Horwitz LI. “Learning by doing”—resident perspectives on developing competency in high-quality discharge care. J Gen Intern Med. 2012;27:1188–1194.
Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation (Learning in Doing: Social, Cognitive and Computational Perspectives). 1991.1st ed. Cambridge, UK: Cambridge University Press;
Stalmeijer RE, Dolmans DH, Wolfhagen IH, Scherpbier AJ. Cognitive apprenticeship in clinical practice: Can it stimulate learning in the opinion of students? Adv Health Sci Educ Theory Pract. 2009;14:535–546.
Ericsson KA. Deliberate practice and acquisition of expert performance: A general overview. Acad Emerg Med. 2008;15:988–994.
Burke RE, Ryan P. Postdischarge clinics: Hospitalist attitudes and experiences. J Hosp Med. 2013;8:578–581.
Young E, Stickrath C, McNulty MC, et al. Internal medicine residents’ perceived responsibility for patients at hospital discharge: A national survey. J Gen Intern Med. 2016;31:1490–1495.
Motamedi SM, Posadas-Calleja J, Straus S, et al. The efficacy of computer-enabled discharge communication interventions: A systematic review. BMJ Qual Saf. 2011;20:403–415.
Sevick LK, Esmail R, Tang K, et al. A systematic review of the cost and cost-effectiveness of electronic discharge communications. BMJ Open. 2017;7:e014722.
Hibbard JH, Greene J. What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood). 2013;32:207–214.