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Resident-led quality improvement (QI) is an important component of resident education yet sustainability of improvement and impact on resident education have rarely been explored. This study describes a resident-led intervention to improve nursing (RN)–provider (MD) communication at discharge—the Discharge Time-Out (DTO)— and explores its uptake and sustainability. One year later, residents were surveyed regarding QI self-efficacy and planned QI involvement. Baseline verbal RN–MD communication at discharge was rare. During DTO implementation, rates of structured communication averaged 56% (341/608) with several months >70%. During the monitoring phase, this fell to 45% and did not recover (833/1852). Participating residents reported increased QI self-efficacy ( P < .05) and increased likelihood of participating in future QI ( P < .05). The DTO increased RN–MD communication but was not sustained. Resident-led QI should explicitly address sustainability to achieve improvement and educational objectives. To foster resident education and avoid short-lived, low-impact projects, increased attention should be given to sustainability of resident-led QI.

Background The coronavirus disease 2019 pandemic has contributed to growing demand for mental health services, but patients face significant barriers to accessing care. Direct-to-consumer(DTC) telemedicine has been proposed as one way to increase access, yet little is known about its pre-pandemic use for mental healthcare. Objective To characterize patients, providers, and their use of a large nationwide DTC telemedicine platform for mental healthcare. Design Retrospective cross-sectional study. Setting Mental health encounters conducted on the American Well DTC telemedicine platform from 2016 to 2018. Participants Patients and physicians. Main Measures Patient measures included demographics, insurance report, and number of visits. Provider characteristics included specialty, region, and number of encounters. Encounter measures included wait time, visit length and timing, out-of-pocket payment, coupon use, prescription outcome, referral receipt, where care otherwise would have been sought, and patient satisfaction. Factors associated with five-star physician ratings and prescription receipt were assessed using logistic regression. Key Results We analyzed 19,270 mental health encounters between 6708 patients and 1045 providers. Visits were most frequently for anxiety (39.1%) or depression (32.5%), with high satisfaction (4.9/5) across conditions. Patients had a median 2.0 visits for psychiatry (IQR 1.0–3.0) and therapy (IQR 1.0–5.0), compared to 1.0 visit (IQR 1.0–1.0) for urgent care. High satisfaction was positively correlated with prescription receipt (OR 1.89, 95% CI 1.54–2.32) and after-hours timing (aOR 1.18, 95% CI 1.02–1.36). Prescription rates ranged from 79.6% for depression to 32.2% for substance use disorders. Prescription receipt was associated with increased visit frequency (aOR 1.95, 95% CI 1.57–2.42 for ≥ 3 visits). Conclusions As the burden of psychiatric disease grows, DTC telemedicine offers one solution for extending access to mental healthcare. While most encounters were one-off, evidence of some continuity in psychiatry and therapy visits—as well as overall high patient satisfaction—suggests potential for broader DTC telemental health use. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07326-y.