Ready for Discharge? A Survey of Discharge Transition of Care Education and Evaluation in Emergency Medicine Residency Programs

Abstract

This study aimed to assess current education and practices of emergency medicine (EM) residents as perceived by EM program directors to determine if there are deficits in resident discharge handoff training. This survey study was guided by the Kern model for medical curriculum development. A six-member Council of EM Residency Directors (CORD) Transitions of Care task force of EM physicians performed these steps and constructed a survey. The survey was distributed to program residency directors via the CORD listserve and/or direct contact. There were 119 responses to the survey, which were collected using an online survey tool. Over 71% of the 167 American College of Graduate Medical Education (ACGME) accredited EM residency programs were represented. Of those responding, 42.9% of programs reported formal training regarding discharges during initial orientation and 5.9% reported structured curriculum outside of orientation. A majority (73.9%) of programs reported that EM residents were not routinely evaluated on their discharge proficiency. Despite the ACGME requirements requiring formal handoff curriculum and evaluation, many programs do not provide formal curriculum on the discharge transition of care or evaluate EM residents on their discharge proficiency.

Does a Standardized Discharge Communication Tool Improve Resident Performance and Overall Patient Satisfaction?

“…Prior to the pre-intervention phase of the study, the authors performed a thorough literature search 10 – 13 identifying essential components of a discharge conversation and incorporated this data with survey question outcomes data from the hospital site’s ED patient satisfaction survey provider (National Research Corporation Picker Survey, Lincoln, NE). Themes ascribed from this information led to a contributing authors’ consensus, which identified six essential components that should be addressed in a comprehensive discharge conversation (see Appendix 1 ).…”

“…After the pre-intervention phase of the study was completed, a 30-minute lecture consisting of a PowerPoint (Microsoft Corp., Redmond, WA) presentation with background information regarding what constitutes a comprehensive discharge 10 – 13 and introduction of “DC HOME” incorporating the six components of the comprehensive discharge plan was presented at the EM weekly didactic conference where all resident physicians were present. The lecture was followed by a practical, in which each resident present was paired with a co-resident.…”

“…A 2015 survey of 119 Accreditation Council for Graduate Medical Education (ACGME)-accredited EM programs conducted by the Council of Emergency Medicine Residency Directors (CORD) found that 73.9% of EM programs do not evaluate residents on competency in performing effective discharges. 13 It also noted that while only 42.9% of programs provided formal instruction on the discharge process during orientation, a mere 5.9% of programs had structured training beyond this initial orientation period. 13 …”

“… 13 It also noted that while only 42.9% of programs provided formal instruction on the discharge process during orientation, a mere 5.9% of programs had structured training beyond this initial orientation period. 13 …”

Triaging Inpatient Admissions: an Opportunity for Resident Education

“…26,39 EM residency education has also found a lack of standardized approaches to training in transitions of care, in particular the ED to the inpatient handoff. [40][41][42] Although there are areas of overlap in EM and IM graduate medical education (GME) for the triagist role, such as interprofessional communication, we propose there are perspectives that are unique to IM GME. Systems-based thinking and understanding the health care system as it relates to the triagist role has not been defined or discussed in the literature.…”