A transition of care (TOC) process from pediatric to adult medicine ensures that adolescents receive ongoing care into young adulthood, a time of high risk for preventable morbidity and mortality. We explored patient, caregiver, and physician perspectives on ways to improve TOC communication with healthy adolescents. Two researchers conducted key informant interviews with healthy 12- to 18-year-old adolescents, their caregivers, and primary care physicians working in pediatric, internal, and family medicine. Data saturation was reached after interviewing 12 adolescents, 10 caregivers, and 36 physicians. Three themes were identified: perceptions of TOC; effective communication among the triad of adolescents, caregivers, and providers; and early communication about TOC preparation. From these themes, a model of communication was identified and adapted, outlining the communication skills and responsibilities for physicians and patients during TOC. Physicians must understand how to use strong, consistent, adolescent-centered communication to execute effective TOC.

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INTRODUCTION: Excessive administrative tasks have been associated with adverse consequences for doctors and their patients. Furthermore, this burden of non-clinical tasks has been linked to depersonalization, a major component of physician burnout. The Care Team Assistant (CTA) program, established in Nov 2016, provides administrative support for the inpatient medical teams to help optimize patient care and promote wellness.OBJECTIVE: To share the acceptability, feasibility, sustainability, and effectiveness of implementing a CTA program.APPROACH: The program was established in a large, urban, academic, tertiary medical center. A needs assessment included time-motion studies, resident surveys, and drafting of a key driver diagram. Highest impact goals were identified by clinicians, nursing leadership, and administrative stakeholders. A physician lead and project manager were designated, and 5 CTAs were initially hired. Once didactic/clinical training was completed, the CTAs were incorporated into inpatient resident teams and assigned various non-clinical tasks. Program leaders met regularly to discuss the program's development and to ensure quality assurance for the CTAs.OUTCOMES: Acceptability: Resident surveys showed CTAs completing a large percentage of daily administrative tasks with promotion of job satisfaction and time spent in direct clinical care. Feasibility: Initial challenges included a lack of benchmark and guidelines for CTA training. These were iteratively refined with input from CTAs and physician partners. Some CTAs were terminated given inability to meet established markers for competency. Another major challenge was the lack of familiarity with the role and sub-optimal utilization of the CTAs, requiring significant efforts to raise awareness. Effectiveness: The initiative has shown concrete positive impacts on various measures including PCP communication and family-centered rounds. CTAs have also helped address institutional needs relating to capacity management by facilitating earlier discharges. Sustainability: CTAs have become integral members of inpatient teams with involvement in multiple interdisciplinary initiatives. The program continues to grow with 12 current CTAs and expansion to the PICU.CONCLUSIONS: CTAs provide an effective means of reducing administrative burden and improving not only care delivery metrics. Rigorous implementation of a CTA program should include a needs assessment and identification of key target areas of impact. Thoughtful design and expansion informed and supported by stakeholders is key to achieving acceptability, sustainability, and operational success.