Adverse events commonly occur during hospital-to-home transitions and cause substantial morbidity. This study evaluated the effectiveness of Fast Forward Rounds (FFR), a novel educational intervention that aims to foster awareness of the essential elements of transitional care in 3rd-year medical students. FFR consists of two 90-minute sessions using lectures, an interactive video, small-group discussion, and a team-based learning exercise. It emphasizes functional assessment to identify patients at risk for poor discharge outcomes, promotes interdisciplinary collaboration to link vulnerable patients with appropriate services, reviews Medicare and Medicaid reimbursement, and teaches development of comprehensive care plans. Using a pre/posttest design, participants' knowledge, attitudes and behaviors within the domains of transitional care, functional assessment, interdisciplinary team, community resources, and reimbursement were assessed. Of 103 students, 99.0% attended Session 1 and 97.1% attended Session 2 (pretest completion rate 99.0%, posttest 94.1%). Significant improvements were found in all domains, with the largest gains seen in transitional care. After the intervention, 56.0% identified medication errors as the most common source of adverse events after discharge (vs 14.9% before the intervention, P<.001). Significantly more participants reported feeling competent or expert in safely discharging chronically ill patients (66.3% vs 9.8%, P<.001) and in educating patients about discharge medications (75.8% vs 28.4%, P<.001). Participants also reported changes in transitional care behaviors (e.g., 71.6% now review the discharge medication list with patients and caregivers > or =50% of the time (vs 42.3%, P=.002)). A multimodal educational intervention for medical students increased their transitional care knowledge, reported frequency of transitional care behaviors, and perceived competence in managing the discharge process.

NLP of EMRs can be used to identify failed communication attempts between home health nurses and physicians, but other variables mostly explained the association between communication failure and readmission. Communication failures may contribute to readmissions in more-serious clinical situations, an association that this study may have been underpowered to detect.

Caregivers of homebound older adults may have high levels of burden and more vulnerability to social isolation and loneliness, given that their care recipients are more physically frail and isolated. Existing literature has not fully investigated differences between paid and unpaid caregiver burden or their experiences of social isolation. We interviewed paid (n=21) and unpaid family caregivers (n=22) of homebound older adults in a hospital-affiliated geriatric house call program. We used validated survey instruments to measure social isolation, loneliness, and caregiver burden, and semi-structured interviews to solicit qualitative data. In our sample, 42% of caregivers helped with 5+ ADLs and 58% with 5+ iADLs. Using the Caregiver Burden Inventory, burden types between caregivers were compared with chi-squared tests. Compared to paid caregivers, unpaid family caregivers experienced more “developmental” burden such as “missing out on life” (p<0.01). Paid caregivers exhibited more “time” burden, such as “not having a minute’s break from caregiving responsibilities” (p<0.01). 44% of caregivers were considered socially isolated according to the Berkman-Syme Social Index. However, using the UCLA 3-item Loneliness Scale, few caregivers felt lonely (14%). Thematic analysis revealed that family caregivers desired support groups but time pressures limited their participation (23%). Interestingly, smart phones were regularly cited as a tool for alleviating loneliness for paid caregivers when alone on the job (19%), a novel finding. Findings suggest that caregivers of the chronically ill and physically isolated may be at particular risk of social isolation. Network based social support interventions may mitigate some of these vulnerabilities.

National organizations such as the Accreditation Council for Graduate Medical Education, Agency for Healthcare Research and Quality, and Joint Commission have recommended specific strategies to improve resident handoffs, such as dedicated time and space to perform handoffs, standardized templates, and supervision by senior physicians. 1,2 How these best-practice recommendations are implemented across programs is unknown. Program directors are expected to standardize and improve handoffs within their institutions' residency programs. Their perspective on strategies and satisfaction with this process can provide insight into improving handoffs. We describe implementation of recommended handoff strategies in a US cohort of internal medicine residency programs and association with program director satisfaction.