BACKGROUND:In an effort to prevent medical errors, it has been recommended that all healthcare organizations implement a standardized approach to communicating patient information during transitions of care between providers. Most research on these transitions has been conducted in the inpatient setting, with relatively few studies conducted in the outpatient setting. OBJECTIVES: To develop a structured transfer of care program in an academic outpatient continuity practice and evaluate whether this program improved patient safety as measured by the documented completion of patient care tasks at 3 months post-transition. DESIGN: Graduating residents and the corresponding incoming interns inheriting their continuity patient panels were randomized to the pilot structured transfer group or the standard transfer group. The structured transfer group residents were asked to complete written and verbal sign-outs with their interns; the standard transfer group residents continued the current standard of care. PARTICIPANTS: Thirty-two resident-intern pairs in an academic internal medicine residency program in New York City. MAIN MEASURES: Three months after the transition, study investigators evaluated whether patient care tasks assigned by the graduating residents had been successfully completed by the interns in both groups. In addition, follow-up appointments, continuity of care and house officer satisfaction with the sign-out process were evaluated. KEY RESULTS: Among patients seen during the first 3 months, the clinical care tasks were more likely to be completed by interns in the structured group (73 %, n= 49) versus the standard group (46 %, n=28) (adjusted OR 3.21; 95 % CI 1. 55-6.62; p=0.002). This was further enhanced if the intern who saw the patient was also the assigned primary care provider (adjusted OR 4.26; p=0.002). CONCLUSIONS: A structured outpatient sign-out improved the odds of follow-up of important clinical care tasks after the year-end resident clinic transition. Further efforts should be made to improve residents' competency with regard to sign-outs in the ambulatory setting.KEY WORDS: patient safety; transfer of care; handoff; sign-out; continuity of care.

We report the case of a 44-year-old man presenting with abdominal pain and leukocytosis. His initial computed tomography demonstrated a pancreatic head mass concerning for pancreatic adenocarcinoma. However, on further review of the patient's imaging, the mass was determined to be an abscess caused by foreign body ingestion and gastric perforation rather than cancer. This report describes the clinical and radiographic distinctions between pancreatic neoplasia and abscess. It also reviews the pertinent medical literature on how such viscus perforations affect subsequent prognostication and clinical management.

of collaborative learning, students would gain a better understanding of their future roles, which would aid interdisciplinary working relationships. What was tried? Selected medical students on a paediatric attachment and final-year pharmacy students were placed in mixed groups of approximately 30 students per group. Over the academic year, we conducted six 3-hour workshops on theoretical and practical aspects of prescribing. Students were split into smaller mixed groups and together worked through realistic prescribing scenarios.A workbook of scenarios and an accompanying slide show were prepared. These resources were developed by the present authors to allow the course to be taught by a variety of instructors, thereby improving its sustainability. The session was run in a teaching room in the medical school by a doctor and a pharmacist.At the end of each session, students were asked to complete a feedback form. We ran two mixed focus groups to allow students to comment on the usefulness of the teaching and resources. What lessons were learned? Both groups of students had little prior teaching on practical prescribing. All of the medical students (n = 43) and 86.6% of the pharmacy students (71/82) found the session relevant. Both sets wanted more prescribing teaching in their courses. The majority of those who did not consider the session relevant found it to be overly geared towards medical students. One of the challenges involved adjusting the curriculum to meet the needs of both student sets.Another difficulty involved the coordination of the teaching staff, students and administrators of two different courses. Numerous logistical difficulties arose. The drive of the authors helped to overcome this to some degree, but the issue creates problems in integrating the course into the curriculum on a long-term basis.Pharmacy students (91.7%) and medical students (94.6%) found it useful to learn in an interdisciplinary group, which represented a new experience for both sets of students. Students had little prior knowledge of one another's roles. Some students revealed prejudices about the other group; some pharmacy students said they perceived doctors as 'being intimidating', and some medical students considered pharmacists to be overly oriented on 'fault-finding'. The students felt the relaxed nature of the session helped to dispel stereotypes and considered it would improve future working relationships.Overall, the students felt the mixed sessions gave them a unique opportunity to work with other disciplines and understand the roles of different health professionals. We were surprised by the extent to which student perceptions were altered by the session. Although there are logistical difficulties, this is a worthwhile endeavour and should be continued and integrated as a formal part of the joint undergraduate curriculum in this area and others.

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