Eric Young1,2, Chad Stickrath3, Monica C McNulty4, Aaron J Calderon5, Elizabeth Chapman6, Jed D Gonzalo7, Ethan F Kuperman8,9, Max Lopez10,11, Christopher J Smith12, Joseph R Sweigart13, Cecelia N Theobald14, Robert E Burke4,15. 1. University of Colorado, Anschutz Medical Campus, Aurora, CO, USA. eric.young@ucdenver.edu. 2. VA Eastern Colorado Healthcare System, Denver, CO, USA. eric.young@ucdenver.edu. 3. University of Colorado, Colorado Springs Branch, Colorado Springs, CO, USA. 4. University of Colorado, Anschutz Medical Campus, Aurora, CO, USA. 5. Saint Joseph Hospital, Denver, CO, USA. 6. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 7. Pennsylvania State University College of Medicine, Hershey, PA, USA. 8. University of Iowa Carver College of Medicine, Iowa City, IA, USA. 9. Iowa City VA Medical Center, Iowa City, IA, USA. 10. University of Vermont College of Medicine, Burlington, VT, USA. 11. University of Mississippi Medical Center, Jackson, MS, USA. 12. University of Nebraska Medical Center, Omaha, NE, USA. 13. University of Kentucky College of Medicine, Lexington, KY, USA. 14. Vanderbilt University Medical Center, Nashville, TN, USA. 15. VA Eastern Colorado Healthcare System, Denver, CO, USA.
Abstract
BACKGROUND: Medical residents are routinely entrusted with transitions of care, yet little is known about the duration or content of their perceived responsibility for patients they discharge from the hospital. OBJECTIVE: To examine the duration and content of internal medicine residents' perceived responsibility for patients they discharge from the hospital. The secondary objective was to determine whether specific individual experiences and characteristics correlate with perceived responsibility. DESIGN: Multi-site, cross-sectional 24-question survey delivered via email or paper-based form. PARTICIPANTS: Internal medicine residents (post-graduate years 1-3) at nine university and community-based internal medicine training programs in the United States. MAIN MEASURES: Perceived responsibility for patients after discharge as measured by a previously developed single-item tool for duration of responsibility and novel domain-specific questions assessing attitudes towards specific transition of care behaviors. KEY RESULTS: Of 817 residents surveyed, 469 responded (57.4 %). One quarter of residents (26.1 %) indicated that their responsibility for patients ended at discharge, while 19.3 % reported perceived responsibility extending beyond 2 weeks. Perceived duration of responsibility did not correlate with level of training (P = 0.57), program type (P = 0.28), career path (P = 0.12), or presence of burnout (P = 0.59). The majority of residents indicated they were responsible for six of eight transitional care tasks (85.1-99.3 % strongly agree or agree). Approximately half of residents (57 %) indicated that it was their responsibility to directly contact patients' primary care providers at discharge. and 21.6 % indicated that it was their responsibility to ensure that patients attended their follow-up appointments. CONCLUSIONS: Internal medicine residents demonstrate variability in perceived duration of responsibility for recently discharged patients. Neither the duration nor the content of residents' perceived responsibility was consistently associated with level of training, program type, career path, or burnout, suggesting there may be unmeasured factors such as professional role modeling that shape these perceptions.
BACKGROUND: Medical residents are routinely entrusted with transitions of care, yet little is known about the duration or content of their perceived responsibility for patients they discharge from the hospital. OBJECTIVE: To examine the duration and content of internal medicine residents' perceived responsibility for patients they discharge from the hospital. The secondary objective was to determine whether specific individual experiences and characteristics correlate with perceived responsibility. DESIGN: Multi-site, cross-sectional 24-question survey delivered via email or paper-based form. PARTICIPANTS: Internal medicine residents (post-graduate years 1-3) at nine university and community-based internal medicine training programs in the United States. MAIN MEASURES: Perceived responsibility for patients after discharge as measured by a previously developed single-item tool for duration of responsibility and novel domain-specific questions assessing attitudes towards specific transition of care behaviors. KEY RESULTS: Of 817 residents surveyed, 469 responded (57.4 %). One quarter of residents (26.1 %) indicated that their responsibility for patients ended at discharge, while 19.3 % reported perceived responsibility extending beyond 2 weeks. Perceived duration of responsibility did not correlate with level of training (P = 0.57), program type (P = 0.28), career path (P = 0.12), or presence of burnout (P = 0.59). The majority of residents indicated they were responsible for six of eight transitional care tasks (85.1-99.3 % strongly agree or agree). Approximately half of residents (57 %) indicated that it was their responsibility to directly contact patients' primary care providers at discharge. and 21.6 % indicated that it was their responsibility to ensure that patients attended their follow-up appointments. CONCLUSIONS: Internal medicine residents demonstrate variability in perceived duration of responsibility for recently discharged patients. Neither the duration nor the content of residents' perceived responsibility was consistently associated with level of training, program type, career path, or burnout, suggesting there may be unmeasured factors such as professional role modeling that shape these perceptions.
Entities:
Keywords:
graduate medical education; internal medicine; readmissions; transitions of care
Authors: Maxine A Papadakis; Arianne Teherani; Mary A Banach; Timothy R Knettler; Susan L Rattner; David T Stern; J Jon Veloski; Carol S Hodgson Journal: N Engl J Med Date: 2005-12-22 Impact factor: 91.245
Authors: Adrian F Hernandez; Melissa A Greiner; Gregg C Fonarow; Bradley G Hammill; Paul A Heidenreich; Clyde W Yancy; Eric D Peterson; Lesley H Curtis Journal: JAMA Date: 2010-05-05 Impact factor: 56.272
Authors: Anuj K Dalal; Christopher L Roy; Eric G Poon; Deborah H Williams; Nyryan Nolido; Cathy Yoon; Jonas Budris; Tejal Gandhi; David W Bates; Jeffrey L Schnipper Journal: J Am Med Inform Assoc Date: 2013-10-23 Impact factor: 4.497
Authors: Vincenza Snow; Dennis Beck; Tina Budnitz; Doriane C Miller; Jane Potter; Robert L Wears; Kevin B Weiss; Mark V Williams Journal: J Hosp Med Date: 2009-07 Impact factor: 2.960
Authors: Patricia A Valverde; Roman Ayele; Chelsea Leonard; Ethan Cumbler; Rebecca Allyn; Robert E Burke Journal: J Gen Intern Med Date: 2021-02-02 Impact factor: 6.473