Abstract
BackgroundThere are limited competency-based educational curricula for transitions of care education (TOC) for internal medicine (IM) residency programs. The University of Colorado implemented a virtual interdisciplinary conference call, TEAM (Transitions Expectation and Management), between providers on the inpatient Acute Care of the Elder (ACE) unit and the outpatient Seniors Clinic at the University of Colorado Hospital. Residents rotating on the ACE unit participated in weekly conferences discussing Seniors Clinic patients recently discharged, or currently hospitalized, to address clinical concerns pertaining to TOC. Our goals were to understand resident perceptions of the educational value of these conferences, and to determine if these experiences changed attitudes or practice related to care transitions.MethodsWe performed an Institutional Review Board-approved qualitative study of IM housestaff who rotated on the ACE unit during 2018–2019. Semi-structured interviews were conducted to understand perceptions of the value of TEAM calls for residents’ own practice and the impact on patient care. Data was analyzed inductively, guided by thematic analysis.ResultsOf the 32 IM residents and interns who rotated on ACE and were invited to participate, 11 agreed to an interview. Three key themes emerged from interviews that highlighted residents’ experiences identifying and navigating some of their educational ‘blind spots:’ 1) Awareness of patient social complexities, 2) Bridging gaps in communication across healthcare settings, 3) Recognizing the value of other disciplines during transitions.ConclusionsThis study highlights learner perspectives of the benefit of interdisciplinary conference calls between inpatient and outpatient providers to enhance transitions of care, which provide meaningful feedback and serve as a vehicle for residents to recognize the impact of their care decisions in the broader spectrum of patients’ experience during hospital discharge. Educators can maximize the value of these experiences by promoting reflective debriefs with residents and bringing to light previously unrecognized knowledge gaps around hospital discharge.
Highlights
There are limited competency-based educational curricula for transitions of care education (TOC) for internal medicine (IM) residency programs
Multiple components contribute to an ideal transition of care (TOC) following hospitalization, including communication of information, medication safety, optimization of community resources, patient education, care coordination across team members, and monitoring/managing symptoms after discharge [1]
The Extension for Community Health Outcomes-Care Transitions (ECHO-CT), a novel program involving interdisciplinary videoconferences for transitions of care was implemented for providers to discuss posthospitalization skilled nursing facility (SNF) patients
Summary
There are limited competency-based educational curricula for transitions of care education (TOC) for internal medicine (IM) residency programs. Residents rotating on the ACE unit participated in weekly conferences discussing Seniors Clinic patients recently discharged, or currently hospitalized, to address clinical concerns pertaining to TOC. The Extension for Community Health Outcomes-Care Transitions (ECHO-CT), a novel program involving interdisciplinary videoconferences for transitions of care was implemented for providers to discuss posthospitalization skilled nursing facility (SNF) patients. This program led to a significant improvement in 30-day hospital readmissions, SNF length of stay, and 30-day total health care costs for patients [4]. Models of integrated communication across sites of care have not been widely adopted, and many academic centers rely on written materials alone to bridge the gap between sites of care
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