Care transitions occur between providers on a single team, between teams on a service, and between services. They also occur between inpatient and ambulatory providers. As this discontinuity introduces potential for error, care transitions are a major focus for education and quality improvement. Most published interventions target transitions during hospitalization, specifically handoffs.
To describe an ambulatory resident curriculum that teaches care transitions by (1) prioritizing evaluation of patients in transition, (2) placing residents on the “receiving end” for discharged patients, (3) exposing residents to common postdischarge settings, (4) allowing residents to collect and analyze their own data, and (5) facilitating reflection on transition management.
We implemented a 4‐week transitions‐of‐care ambulatory block for residents in our Hospital Medicine Pathway in 2010. Residents evaluate patients in transition during half‐day experiences in multiple ambulatory settings: postdischarge and diabetes follow‐up clinics, clinics for the unstably housed, long‐term care, home health, hospice, and home visits. Clinical preceptors prioritize evaluation of recently discharged patients. In providing usual care, the resident notes patient features that increase transition risk (e.g., lack of primary care), assesses understanding and personal impact of transition, and evaluates discharge summary quality. Threats to safe transition (e.g., in communication, management, medication, or follow‐up) and outcomes are noted in an electronic Transition Log. Using a Transition Log summary, each resident generates a 1–2 page narrative describing evolution in perspectives on care transitions. All residents complete intake and exit surveys, addressing related knowledge, skills, attitudes, and behaviors. To date, 19 residents have completed the rotation; 42% (8) have provided access to curricular materials for formal evaluation. Data analysis shows statistically significant improvements across nearly all self‐rated knowledge (e.g., familiarity with transition literature) and confidence metrics (e.g., “Rate your confidence in managing care transitions for the following groups . . .”) and positive changes in selected attitudes (e.g., “Most elements of … transition are in the … team's control”), One hundred percent of residents have identified transition threats and generated personalized “commitment to change” statements (e.g., “Consider home health for my continuity clinic patients more often”). Data analysis is ongoing, including identified transition threats, baseline resident behaviors, and perceived effects of the rotation on practice.
Structured reflection related to posttransition ambulatory patient care represents a novel approach to transition education. The Transitions of Care Ambulatory Block broadens resident understanding of the health care system, provides a retrospective view on the elements of a quality transition, and improves perceived knowledge, confidence and attitudes.
To cite this abstract:Best J. The Transitions‐of‐Care Ambulatory Block: A Novel Approach to Transition Education. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 136. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/the-transitionsofcare-ambulatory-block-a-novel-approach-to-transition-education/. Accessed April 21, 2019.