Healthcare delivery has become divided into discrete silos of care. With a growing separation between inpatient and outpatient services, transitions of care have become an increasingly vulnerable time for patients. For patients at San Francisco General Hospital (SFGH), a large safety net institution, these transitions often include the added complexities of limited ambulatory health access, low health literacy, and social isolation. The limited capacity of the local primary care clinic network to accept new patients created the need for a clinic that can see patients in a timely manner postdischarge, as many patients have immediate needs requiring a followup visit within 12 weeks of discharge. This postdischarge clinic (Bridge Clinic) is a potentially rich environment in which to develop medical education innovations to improve systemsbased practice related to transitions of care.
To establish a clinical experience for internal medicine housestaffhouse staff that facilitates experiential learning about transitions of care, as a pilot for a larger integrated care transitions curriculum.
We have piloted a posthospitalization discharge clinic (Bridge Clinic) staffed by hospitalists and internal medicine housestaffhouse staff, with 13 residents spending one or more half days in clinic over a 4month period (AugustNovember 2011). Participating housestaffhouse staff received didactics on the core principles of quality and safety during care transitions and applied these skills during patient encounters. During the pilot period, we had a 70 % show rate, with 78 patients seen in the clinic. The majority of patients did not have a primary care provider (88%) or access to health coverage (79%). Among learners who returned surveys (9/13), all respondents (nine of nine) either agreed or strongly agreed that they have an understanding of “key issues affecting safe transitions of care” after their time in Bridge Clinic, and that this experience would “help [them] to plan safe discharges in the future.” Residents observed themes that highlighted the value of this unique educational experience, including the importance of examining financial barriers to obtaining medications after discharge, ensuring linkage to new primary care and specialist providers for patients with new diagnoses, and facilitating access to insurance and health access plans.
This pilot supports the value of using a discharge clinic experience to educate trainees on the principles of transitions in care and provides a launch point for future curricular development. We aim to integrate this curriculum with residencywide education innovations related to safe transitions of care, with a unifying goal of improving patient care and systemsbased practice for vulnerable populations around the time of hospital discharge.
To cite this abstract:Chen B, Thomas L, Schneidermann M, Azari S. Pilot Use of a Discharge Clinic to Develop an Educational Experience in Transitions of Care for Internal Medicine Housestaff. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97694. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/pilot-use-of-a-discharge-clinic-to-develop-an-educational-experience-in-transitions-of-care-for-internal-medicine-housestaff/. Accessed November 18, 2019.