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Bridging care transitions: findings from a resident-staffed early postdischarge program
Jennifer I Lee1, Fran Ganz-Lord, Judy Tung
1Dr. Lee is assistant professor, Division of Hospital Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York. Dr. Ganz-Lord is assistant professor, Weill Cornell Internal Medicine Associates, Department of Medicine, Weill Cornell Medical College, New York, New York. Dr. Tung is associate professor, Weill Cornell Internal Medicine Associates, and acting chief, Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York. Dr. Bishop is assistant professor, Weill Cornell Internal Medicine Associates, Department of Medicine, and Division of Outcomes and Effectiveness, Department of Public Health, Weill Cornell Medical College, New York, New York. Ms. DeJesus is director, Department of Social Work and Care Coordination, New York-Presbyterian Hospital, New York, New York. Ms. Ocampo is improvement manager, Division of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York. Ms. Tinghitella is improvement manager, Division of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York. Dr. Scott is vice president, Division of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York.
Problem:
Academic medical centers face unique challenges to ensuring patient safety after a hospital discharge, including those related to providing patient follow-up care in practices staffed by residents who are not comfortable managing care transitions.
Approach:
In 2011, the authors designed a quality improvement program for early postdischarge follow-up (bridge visits) at a resident primary care outpatient practice, using existing resources. The authors added a unique appointment template to the outpatient electronic health record to guide residents during the visit. Residents completed both postvisit and postprogram surveys regarding their experience with the program, and patients completed postvisit phone surveys regarding their satisfaction with the program.
Outcomes:
Fifty-eight residents completed postvisit surveys, of which 31.0% (18/58) reported problems with medication reconciliation and 25.9% (15/58) with adherence to discharge medications. Of those residents who completed postprogram surveys, almost half (18/38; 47.4%) agreed that their experience changed the way they discharge patients. Nearly all patients who responded to the postvisit phone surveys reported that the program reinforced their discharge and medication instructions (44/46; 95.7%); 81.8% (18/22) of patients with established providers did not mind seeing an interim physician for expedited postdischarge care.
Next Steps:
An early postdischarge program at a resident outpatient primary care practice is valuable both in ensuring patient safety and as a model to promote experiential learning in medical education. Findings from this study will be used to develop a formal curriculum in care transitions for all residents.
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