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

“Ms. B Changes Doctors”: Using a Comic and Patient Transition Packet to Engineer Patient-Oriented Clinic Handoffs (EPOCH)

“…Residents were given suggested criteria to select high-risk patients. 3,9,10 Approximately 30 IM residents per class have clinic at this site, supervised by faculty preceptors, consistent with Accreditation Council for Graduate Medical Education regulations. 14 This study was approved by the University of Chicago Institutional Review Board.…”

“…5,6 Although several studies in IM have demonstrated improved outcomes with clinic handoff interventions, few have focused on incorporating the patient perspective or assessing patientcentered outcomes to improve care. [7][8][9][10][11] One intervention that educated departing residents on how to discuss the handoff with patients and employed a handoff notification letter increased patient satisfaction. 11 However, several intervention studies were not able to improve missed visits with the new PCP after the handoff, which may be due to patient factors.…”

“…11 However, several intervention studies were not able to improve missed visits with the new PCP after the handoff, which may be due to patient factors. 9,10 The Institute of Medicine and the Agency for Healthcare Research and Quality promote patient-centered care as a means of improving health care quality. 12,13 Thus, incorporating patients' perspectives will be necessary to further improve clinic handoffs and create patient-centered care transitions.…”

Transitions of Care in Continuity Clinic—Lessons Learned and Next Steps

“…These include reducing the variability in the initial outpatient caseload of incoming residents; 6 integrating patient-centered transition information; 7 standardizing templates for electronic, written and verbal sign-out; 8,9 and incorporating a multifaceted approach for transition of high-risk patients. 10,11 Given the high level of medical and social complexity typical of patients seen in resident clinic, targeted interventions aimed at improving care transitions for high-risk patients may be especially relevant.…”

“…As exemplified in one prior study, the sustainability of improvement in outpatient panel transition outcomes should also be assessed. 11 Finally, achieving patient-physician continuity in resident clinic is challenging. Considering the inverse relationship between continuity and transitions of care, and separate from the annual outpatient panel transition of care that was the focus of this study, routine outpatient-to-outpatient care transitions represent an under-recognized, but potentially important patient care transition.…”