Improving Resident Education and Patient Safety: A Method to Balance Initial Caseloads at Academic Year-End Transfer

Young, John Q.; Niehaus, Brian; Lieu, Sandra C; O’Sullivan, Patricia

doi:10.1097/acm.0b013e3181eab8d0

Cited by 20 publications

(11 citation statements)

References 28 publications

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“…One multifaceted handoff intervention in a psychiatry residency clinic demonstrated improved timeliness of follow-up and patient outcomes. 6,7 Two interventions in internal medicine clinics increased the number of handoffs completed and improved the number of clinical tasks that were followed up after the transition. 8,9 To date, there has been little examination of the patient perspective of year-end clinic handoffs.…”

Section: Introductionmentioning

confidence: 99%

What Do Patients Think About Year-End Resident Continuity Clinic Handoffs?: A Qualitative Study

et al. 2013

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BACKGROUND:Although Internal Medicine year-end resident clinic handoffs affect numerous patients, little research has described patients' perspectives of the experience. OBJECTIVE: To describe patients' perceptions of positive and negative experiences pertaining to the year-end clinic handoff; to rate patient satisfaction with aspects of the clinic handoff and identify whether or not patients could name their new physicians. DESIGN: Qualitative study design using semi-structured interviews. PARTICIPANTS: High-risk patients who underwent a year-end clinic handoff in July 2011. MEASUREMENTS: Three months post-handoff, telephone interviews were conducted with patients to elicit their perceptions of positive and negative experiences. An initial coding classification was developed and applied to transcripts. Patients were also asked to name their primary care physician (PCP) and rate their satisfaction with the handoff. RESULTS: In all, 103 telephone interviews were completed. Patient experiences regarding clinic handoffs were categorized into four themes: (1) doctor-patient relationships (i.e. difficulty building rapport); (2) clinic logistics (i.e. difficulty rescheduling appointments); (3) process of the care transition (i.e. patient unaware transition occurred); and (4) patient safety-related issues (i.e. missed tests). Only 59 % of patients could correctly name their new PCP. Patients who reported that they were informed of the clinic transition by letter or by telephone call from their new PCP were more likely to correctly name them (65 % vs. 32 % p=0.007), report that their new doctor assumed care for them immediately ( Patients who reported being aware of the medical education mission of the clinic tended to be more understanding of the handoff process. CONCLUSIONS:Patients face unique challenges during year-end clinic handoffs and provide insights into areas of improvement for a patient-centered handoff.

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Section: Introductionmentioning

confidence: 99%

What Do Patients Think About Year-End Resident Continuity Clinic Handoffs?: A Qualitative Study

et al. 2013

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“…4,5 In many programs there is an absence of efforts to balance the distribution of patients who have complex conditions to their new resident providers, which makes it difficult to rebalance caseloads, a method used in ambulatory psychiatry. 16 Recording end-of-residency handoff information in the EHR has the advantage that all the handoff information is retained until the patient presents for follow-up, and that the information is accessible to all providers. Although oral handoffs were the second most commonly reported approach, information transferred in this fashion may be lost unless the patient follows up with the identified provider in a reasonable time frame.…”

Section: Discussionmentioning

confidence: 99%

Current Practice in End-of-Residency Handoffs: A Survey of Internal Medicine–Pediatrics Program Directors

Donnelly¹,

Clauser²,

Tractenberg³

2013

Journal of Graduate Medical Education

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Background End-of-residency outpatient handoffs affect at least 1 million patients per year, yet there is no consensus on best practices. Objective To explore the use of formal systems for end-of-residency clinic handoffs in internal medicine–pediatrics residency (Med-Peds) programs, and their associated categorical internal medicine and pediatrics programs. Methods We surveyed Med-Peds program directors about their programs' system for handing off ambulatory continuity patients. Results Our response rate was 85% (67 of 79 programs). Thirty-one programs (46%) reported having a system for end-of-residency handoffs. Of the 30 that offered detailed information, 22 (73%) formally introduced the program to residents, 12 (40%) standardized the handoff, and 14 (47%) used multiple methods for information exchange, with the electronic health record and oral transfer of information (15 of 30, 50%) the most common. Six programs (20%) indicated they did not offer residents protected time to complete end-of-residency handoffs, and 13 programs (43%) did not identify a specific postgraduate year level for residents to whom patients were handed off. Programs were more likely to have a system for end-of-residency handoffs if another categorical program at their institution also had one (P < .001). Conclusions Fewer than half of responding Med-Peds programs have outpatient handoff systems in place. Inclusion of end-of-residency handoff information in the electronic health record may represent a best practice that has the potential of enhancing continuity and safety of care for patients in resident continuity clinics.

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“…2,5,6 Despite the risks of clinic handoffs, few residency programs have outpatient handoff systems in place, and the few interventions that address clinic handoffs have not reported sustained improvements in patient safety. [7][8][9][10][11][12][13] A multifaceted intervention in psychiatry improved timely follow-up after the clinic handoff. 8,9 In internal medicine, one standardized sign-out intervention improved the number of completed clinical tasks after a clinic handoff and another improved the number of handoffs completed by residents.…”

mentioning

confidence: 99%

Patient Safety Outcomes after Two Years of an Enhanced Internal Medicine Residency Clinic Handoff

Pincavage¹,

Prochaska²,

Dahlstrom³

et al. 2014

The American Journal of Medicine

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Improving Resident Education and Patient Safety: A Method to Balance Initial Caseloads at Academic Year-End Transfer

Cited by 20 publications

References 28 publications

What Do Patients Think About Year-End Resident Continuity Clinic Handoffs?: A Qualitative Study

What Do Patients Think About Year-End Resident Continuity Clinic Handoffs?: A Qualitative Study

Current Practice in End-of-Residency Handoffs: A Survey of Internal Medicine–Pediatrics Program Directors

Patient Safety Outcomes after Two Years of an Enhanced Internal Medicine Residency Clinic Handoff

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