TY - JOUR
T1 - Toward safe hospital discharge
T2 - A transitions in care curriculum for medical students
AU - Bray-Hall, Susan
AU - Schmidt, Katrina
AU - Aagaard, Eva
N1 - Funding Information:
Funding: This study was supported by a grant from the John A. Hartford Center of Excellence, University of Colorado Denver. The authors wish to thank Dr. Adam Abraham who helped secure the grant and Drs. Daniel Matlock, Ethan Cumbler, and Jeannette Guerrasio for facilitating the small group sessions.
Funding Information:
Acknowledgments: Dr. Bray-Hall has received funding from the John A. Hartford Foundation, Center of Excellence, Division of Geriatrics, University of Colorado.
PY - 2010/8
Y1 - 2010/8
N2 - BACKGROUND: Medical errors often occur when patients move between care settings. Physicians generally receive little formal education on improving patient care transitions. OBJECTIVE: To develop a sustainable and effective Transition in Care Curriculum (TICC). Specific goals were to increase student confidence in and knowledge of skills necessary during care transitions at the time of hospital discharge, and to quantify the frequency of student-identified medication discrepancies during a post-discharge home visit. Design: TICC was delivered to 136 3rd-year medical students during their required inpatient medicine clerkship at six urban Denver hospitals. TICC consists of small and large group interactive sessions and self-directed learning exercises to provide foundational knowledge of care transitions. Experiential learning occurs through direct patient care at the time of discharge and during a follow-up home, hospice, or skilled nursing visit. Students completed a pre-post confidence measure, short answer and multiple choice questions, a post-clerkship satisfaction survey, and a standardized medication discrepancy tool. MAIN RESULTS: Overall combined confidence in transitional care skills improved following the TICC from an average score of 2.7 (SD 0.9) to 4.0 (SD 0.8) (p<0.01) on a 5-point confidence scale. They scored an average of 77% on the written discharge plan portion of the final exam. Students rated the usefulness of TICC at a mean of 3.1 (SD 0.7), above the combined mean of 2.7 for project work in all required clerkships. Students identified medication discrepancies during 43% of post-discharge visits (58 of 136). The most common reasons for discrepancies were patient lack of understanding of instructions and intentional non-adherence to medication plan. CONCLUSION: TICC represents a feasible and effective program to teach evidence-based transitional care.
AB - BACKGROUND: Medical errors often occur when patients move between care settings. Physicians generally receive little formal education on improving patient care transitions. OBJECTIVE: To develop a sustainable and effective Transition in Care Curriculum (TICC). Specific goals were to increase student confidence in and knowledge of skills necessary during care transitions at the time of hospital discharge, and to quantify the frequency of student-identified medication discrepancies during a post-discharge home visit. Design: TICC was delivered to 136 3rd-year medical students during their required inpatient medicine clerkship at six urban Denver hospitals. TICC consists of small and large group interactive sessions and self-directed learning exercises to provide foundational knowledge of care transitions. Experiential learning occurs through direct patient care at the time of discharge and during a follow-up home, hospice, or skilled nursing visit. Students completed a pre-post confidence measure, short answer and multiple choice questions, a post-clerkship satisfaction survey, and a standardized medication discrepancy tool. MAIN RESULTS: Overall combined confidence in transitional care skills improved following the TICC from an average score of 2.7 (SD 0.9) to 4.0 (SD 0.8) (p<0.01) on a 5-point confidence scale. They scored an average of 77% on the written discharge plan portion of the final exam. Students rated the usefulness of TICC at a mean of 3.1 (SD 0.7), above the combined mean of 2.7 for project work in all required clerkships. Students identified medication discrepancies during 43% of post-discharge visits (58 of 136). The most common reasons for discrepancies were patient lack of understanding of instructions and intentional non-adherence to medication plan. CONCLUSION: TICC represents a feasible and effective program to teach evidence-based transitional care.
KW - care transitions
KW - curriculum development/evaluation
KW - home visit
KW - hospital discharge
KW - undergraduate medical education
UR - http://www.scopus.com/inward/record.url?scp=77955696270&partnerID=8YFLogxK
U2 - 10.1007/s11606-010-1364-3
DO - 10.1007/s11606-010-1364-3
M3 - Article
C2 - 20443072
AN - SCOPUS:77955696270
SN - 0884-8734
VL - 25
SP - 878
EP - 881
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 8
ER -