LESSONS LEARNED BY MEDICAL STUDENTS IN SYSTEMS-BASED PRACTICE AS PATIENTS TRANSITION THEIR CARE

Ernie L Esquivel, MD*;Diego Sierra;Eduard Pey, BS;Deanna Pereira Jannat-Khah, PhD and Shelene Stine, MD, Weill Cornell Medical College, New York, NY

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 247

Categories: Innovations Abstracts, Transitions of Care

Background:  Patient care may be enhanced as they transition from one health care setting or provider to another.  However, studies have shown that as many as 1 in 5 patients suffer an adverse event within two weeks of discharge. These events include medication errors or inadequate understanding of disease diagnosis and post-discharge instructions.  Such errors are potential targets for quality improvement.  Regulatory bodies have included systems-based practice as one of the core competencies for physicians.  Transitions of care curricula targeted towards medical students have included didactic sessions, workshops or post-discharge phone call or home visit.  We asked whether a structured post-discharge phone call, coupled with students’ reflections on barriers of discharge can be an effective educational intervention leading them to identify future practice improvement methods to enhance transitions of care. 

Purpose: A mandatory graded “Transitions of Care” assignment was developed for students enrolled in the Medicine Clerkship.  Students were asked to conduct a post-discharge follow-up phone call using the Agency for Healthcare Research and Quality (AHRQ) tool.  In addition, students were asked to identify barriers to safe discharge of their patient and to consider ways in which their future practice could be improved.  We performed a qualitative analysis of the assignments and developed themes and sub-themes, using the analytic program Dedoose.  The frequency with which themes were identified by students was tabulated. 

Description: Ninety (90) students enrolled in the Medicine Clerkship submitted a transitions of care assignment.  Issues with patients’ understanding of their discharge diagnosis were identified in 27/83 (32.5%), including inability to articulate their diagnosis.  A majority (46/89, 51.7%) of patients had medication-related issues, most commonly incomplete understanding of indications, inability to obtain medications, noncompliance and side effects.  The phone call revealed issues with post-discharge follow-up in 44/89 (49.4%) patients, leading to failure to attend the appointment due to lack of transportation or forgetting the appointment.  Feedback on the patient’s condition, whether improved or persistent, were incidentally received by students in 38 cases.  Students identified a total of 201 barriers to discharge among 86 patients.  These included issues with scheduling follow-up, poor care coordination, lack of social support systems and health care system-related problems, debilitation and cognitive impairment and lack of access to medications, equipment or transportation.  Finally, students proposed 240 practice improvement interventions to improve transitions of care.  The most common interventions related to increased patient education (42), and enhanced communication with patients (34) and their families (16).  Improved interdisciplinary collaboration (33) and care coordination and discharge planning (18) were frequently noted, as well as greater attention to patient’s psychosocial and financial (26).  Arranging follow-up and performing a post-discharge phone call were recommended. 

Conclusions: Medical students learned robustly about systems-based practice from a transitions of care assignment, which included a post-discharge phone call.  We believe that self-reflective practice and learning within the context of direct patient care offers opportunities for future practice improvement as medical students transition their patients’ care.

To cite this abstract:

Esquivel, EL; Sierra, D; Pey, E; Jannat-Khah, DP; Stine, S . LESSONS LEARNED BY MEDICAL STUDENTS IN SYSTEMS-BASED PRACTICE AS PATIENTS TRANSITION THEIR CARE. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 247. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/lessons-learned-by-medical-students-in-systems-based-practice-as-patients-transition-their-care/. Accessed September 16, 2019.

« Back to Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.