A Safe and Effective Discharge Curriculum Implemented in 11 Internal Medicine Programs

1Banner Good Samaritan Medical Center, Phoenix, AZ
2 Baystate Medical Center, Springfield, MA
3 University of Colorado, Aurora, CO
4 Duke University Medical Center, Durham, NC
5 Summa Health System, Akron, OH

Meeting: Hospital Medicine 2015, March 29-April 1, National Harbor, Md.

Abstract number: 28

Keywords:

Background: The transition out of the hospital is a vulnerable time for patients and families and is ripe for physician training.  We implemented a discharge curriculum focusing on the competence of a ‘Safe and Effective Discharge (SAFE-D) From the Hospital’.  The primary objective for the SAFE-D innovation was to assess the usefulness of direct observation and feedback to determine competence in the process of discharging patients from the hospital.  Our secondary objectives included:  1. To increase attending and resident awareness of core physician behaviors for a SAFE-D   2. To improve the quality of feedback from attendings when they observe residents in the SAFE-D behaviors 3. To assess the usefulness of multi-source feedback on the determination of resident competence and 4. To assess the feasibility of using behavior-based direct observation in assessment for SAFE-D. 

Methods: Eleven Internal Medicine (IM) programs participated in the SAFE-D innovation including 251 attendings and 299 Post Graduate Year 1 residents.  From September 2013 to June 2014, eleven IM programs implemented a workplace direct observation discharge curriculum.  Site principle investigators (PI) from all programs collaborated on monthly conference calls to implement the discharge curriculum by sharing barriers and successes throughout the year.  Faculty and residents were oriented to the discharge curriculum in a 1 hour interactive session led by the site PI. The discharge curriculum consisted of serial direct observations in the following domains: Medication Reconcilliation, Discharge Summary, Patient Communication, Anticipates Post Hospital Needs, Actively Collaborates, and Team Communication.  Attendings observed these domains during their usual work on the wards with the resident.  Attendings rated the resident on a competence 5 point scale from ‘resident cannot perform even with assistance’ to ‘resident can act as an instructor on this skill’.  Attendings gave formative feedback and completed the structured observations until the resident had reached a level of competence defined by being ‘ready for indirect supervision’.  Use of the discharge curriculum was required for all attendings and residents on the wards as part of the educational requirements of the wards rotation.  At the end of the academic year, attendings and residents completed a voluntary survey to assess the objectives of the discharge curriculum.

Results: 119 (47.6%) attendings and 181 (60.5%) residents completed a post innovation survey with the results found in the table. 

Post Intervention Survey of Attendings and Residents

Question: The discharge curriculum…

Attendings % agree

Residents % agree

…made me more aware of core discharge behaviors

60%

51%

provided a structure for giving feedback

67%

57%

…Increased confidence in assessing how well the resident engages with other health professionals

51%

n/a

…was easy to implement on the wards

46%

57%

…was more effective than their prior practice of …teaching core behaviors in thedischarge process

79%

n/a

…increased confidence in assessing resident competence

65%

n/a

…helped me understand the requirements to progress toward increased independence

n/a

64%

Conclusions: The SAFE-D curriculum improved attending and resident awareness of discharge behaviors, increased attending direct observation and increased feedback.  Applying the educational method of direct observation and feedback for the purpose of advancing the resident by competence was shown to be useful for both the attending and the resident.

To cite this abstract:

O'Malley C, Meade L, Suddarth K, Zaas A, Jones R. A Safe and Effective Discharge Curriculum Implemented in 11 Internal Medicine Programs. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Abstract 28. Journal of Hospital Medicine. 2015; 10 (suppl 2). https://www.shmabstracts.com/abstract/a-safe-and-effective-discharge-curriculum-implemented-in-11-internal-medicine-programs/. Accessed July 21, 2019.

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