Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey

Abstract

BACKGROUND: Medical residents are routinely entrusted with transitions of care, yet little is known about the duration or content of their perceived responsibility for patients they discharge from the hospital. OBJECTIVE: To examine the duration and content of internal medicine residents' perceived responsibility for patients they discharge from the hospital. The secondary objective was to determine whether specific individual experiences and characteristics correlate with perceived responsibility. DESIGN: Multi-site, cross-sectional 24-question survey delivered via email or paper-based form. PARTICIPANTS: Internal medicine residents (post-graduate years 1-3) at nine university and community-based internal medicine training programs in the United States. MAIN MEASURES: Perceived responsibility for patients after discharge as measured by a previously developed single-item tool for duration of responsibility and novel domain-specific questions assessing attitudes towards specific transition of care behaviors. KEY RESULTS: Of 817 residents surveyed, 469 responded (57.4 %). One quarter of residents (26.1 %) indicated that their responsibility for patients ended at discharge, while 19.3 % reported perceived responsibility extending beyond 2 weeks. Perceived duration of responsibility did not correlate with level of training (P = 0.57), program type (P = 0.28), career path (P = 0.12), or presence of burnout (P = 0.59). The majority of residents indicated they were responsible for six of eight transitional care tasks (85.1-99.3 % strongly agree or agree). Approximately half of residents (57 %) indicated that it was their responsibility to directly contact patients' primary care providers at discharge. and 21.6 % indicated that it was their responsibility to ensure that patients attended their follow-up appointments. CONCLUSIONS: Internal medicine residents demonstrate variability in perceived duration of responsibility for recently discharged patients. Neither the duration nor the content of residents' perceived responsibility was consistently associated with level of training, program type, career path, or burnout, suggesting there may be unmeasured factors such as professional role modeling that shape these perceptions.

Patients’ and caregivers’ perspectives on factors that influence understanding of and adherence to hospital discharge instructions: a qualitative study

“…21 This factor is of timely importance given recent work showing that both inpatient and outpatient physicians rarely feel responsible for patient care and adherence after discharge. 22,23 Providers who feel a sense of responsibility are more likely to spend the necessary time at discharge to optimize the transition from hospital to home. Our results highlight a missed opportunity to address patients' existing relationships with their circle of care and suggest that the best health care provider to follow up on discharge instructions may be the one the patient has the closest perceived relationship with.…”

Training and Performance Differences in US Internal Medicine Residents Trained in Community- and University-Based Programs – a Systematic Review

“…The median sample size for the included studies were 287.5 [range=127-444]. Among the included studies, outcome of interest was categorized by any of the following: medical knowledge [n=2] (Hicks, Gonzales, Morton, Gibbons, Wigton et al 2000;Atsawarungruangkit et al, 2015); faculty encouraging counseling/ training [n=2] (Berkenblit, Sosman, & Bass, et al 2012;Catalanotti et al 2014); patient safety and care [n=4] (Schultz et al 1994;Jain, Wyatt, Burke, Sepkowitz, & Begier, 2009;Young, E., Stickrath, McNulty, Calderon., Chapman, et al, 2016;Khandelwal, Zemore, & Hemmerling, 2018 ; 3 (= 1.5)…”

“…Three studies (Schultz et al, 1994;Khandelwal et al, 2018;Young et al, 2016) explored residents practice about HIV counseling and knowledge about HIV screening. Outcomes of two studies (Schultz et al, 1994;Young et al, 2016) met the description for patient safety and care.…”

“…Three studies (Schultz et al, 1994;Khandelwal et al, 2018;Young et al, 2016) explored residents practice about HIV counseling and knowledge about HIV screening. Outcomes of two studies (Schultz et al, 1994;Young et al, 2016) met the description for patient safety and care. Shultz et al (1994) reported significant differences in terms of poor knowledge on questions regarding HIV drugs and risk factors such as risk factors or cervical cancer [P= 0.02] between UBP and CBP; however authors did not report, residents of which program had poor knowledge about HIV counseling.…”

Capsule Commentary on Young et al., Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey

“…Young et al 1 reignite the debate regarding when a hospitalist's responsibility for the patient should end. 2 In this multi-center study, residents were surveyed on their perceived duration of post-discharge responsibility.…”