Outcomes for Resident-Identified High-Risk Patients and Resident Perspectives of Year-End Continuity Clinic Handoffs
ABSTRACT Many patients nationwide change their primary care physician (PCP) when internal medicine (IM) residents graduate. Few studies have examined this handoff.
To assess patient outcomes and resident perspectives after the year-end continuity clinic handoff
Patients who underwent a year-end clinic handoff in July 2010 and a comparison group of all other resident clinic patients from 2009-2011. PGY2 IM residents surveyed from 2010-2011.
Percent of high-risk patients after the clinic handoff scheduled for an appointment, who saw their assigned PCP, lost to follow-up, or had an acute visit (ED or hospitalization). Perceptions of PGY2 IM residents surveyed after receiving a clinic handoff.
Thirty graduating residents identified 258 high-risk patients. While nearly all patients (97 %) were scheduled, 29 % missed or cancelled their first new PCP visit. Only 44 % of patients saw the correct PCP and six months later, one-fifth were lost to follow-up. Patients not seen by a new PCP after the handoff were less likely to have appropriate follow-up for pending tests (0 % vs. 63 %, P < 0.001). A higher mean no show rate (NSR) was observed among patients who missed their first new PCP visit (22 % vs. 16 % NSR, p < 0.001) and those lost to follow-up (21 % vs. 17 % NSR, p = 0.019). While 47 % of residents worried about missing important data during the handoff, 47 % reported that they do not perceive patients as "theirs" until they are seen by them in clinic.
While most patients were scheduled for appointments after a clinic handoff, many did not see the correct resident and one-fifth were lost to follow-up. Patients who miss appointments are especially at risk of poor clinic handoff outcomes. Future efforts should improve patient attendance to their first new PCP visit and increase PCP ownership.
SourceAvailable from: Victor O Kolade[Show abstract] [Hide abstract]
ABSTRACT: Background: Transfer of clinic patients from graduating residents to interns or junior residents occurs every year, affecting large numbers of patients. Breaches in care continuity may occur, with potential for risk to patient safety. Several guidelines have been developed for implementing standardized inpatient sign-outs, but no specific guidelines exist for outpatient handover. Methods: Residents in primary care programs - internal medicine, family medicine, and pediatrics - at a US academic medical center were invited to participate in an online survey. The invitation was extended approximately 2 years after electronic medical record (EMR) rollout began at the institution. Results: Of 71 eligible residents, 22 (31%) responded to the survey. Of these, 18 felt that handover of ambulatory patients was at least moderately important - but only one affirmed the existence of a system for handover. IM residents perceived that they had the highest proportion of high-risk patients (p=0.042); transition-of-care letters were more important to IM residents than other respondents (p=0.041). Conclusion: There is room for improvement in resident acknowledgement of handover processes in continuity clinics. In this study, IM residents attached greater importance to a specific handover tool than other primary care residents. Thus, the different primary care specialties may need to have different handover tools available to them within a shared EMR system.11/2014; 4(5):25087. DOI:10.3402/jchimp.v4.25087
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ABSTRACT: Transitions of patient care responsibility, such as the hand-off of care from primary care physician to hospitalist or between hospital teams during an acute illness, are increasingly the norm in general medicine practice. Such transitions are prone to error and can be detrimental to safe patient care. To address this problem, the Accreditation Council for Graduate Medical Education (ACGME) has highlighted education and oversight of care transitions in the current accreditation system.1Review of the transitions of care literature reveals a common thread. Most of the research focuses on inpatient care transitions.2 Less studied are ambulatory hand-offs (i.e., clinic patients), many of which involve the 7,500 internal medicine residents who graduate residency each year.3 These residents leave behind a cohort of nearly 1 million patients.4 Do these ambulatory patients experience adverse events similar to patients handed off in the hospital setting? Previous analysis from a single academic ...Journal of General Internal Medicine 10/2014; 30(2). DOI:10.1007/s11606-014-3038-z · 3.42 Impact Factor
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ABSTRACT: BACKGROUND Few patient-centered interventions exist to improve year-end residency clinic handoffs. AIM Our purpose was to assess the impact of a patient-centered transition packet and comic on clinic handoff outcomes. SETTING The study was conducted at an academic medicine residency clinic. PARTICIPANTS Participants were patients undergoing resident clinic handoff 2011-2013 PROGRAM DESCRIPTION Two months before the 2012 handoff, patients received a “transition packet” incorporating patient-identified solutions (i.e., a new primary care provider (PCP) welcome letter with photo, certificate of recognition, and visit preparation tool). In 2013, a comic was incorporated to stress the importance of follow-up. PROGRAM EVALUATION Patients were interviewed by phone with response rates of 32 % in 2011, 43 % in 2012 and 36 % in 2013. Most patients who were interviewed were aware of the handoff post-packet (95 %). With the comic, more patients recalled receiving the packet (44 % 2012 vs. 64 % 2013, ppp DISCUSSION A patient-centered transition packet helped prepare patients for clinic handoffs. The comic was associated with increased packet recall and improved follow-up rates.Journal of General Internal Medicine 09/2014; 30(2). DOI:10.1007/s11606-014-3009-4 · 3.42 Impact Factor