An observational pre–post study of re-structuring Medicine inpatient teaching service: Improved continuity of care within constraint of 2011 duty hours

Cheung, Joseph Y.; Müeller, Daniel J.; Blum, Marissa; Ravreby, Hannah; Williams, Paul N.; Moyer, Darilyn V.; Caroline, Malka; Zack, Chad J.; Fisher, Susan G.; Feldman, Arthur M.

doi:10.1016/j.hjdsi.2015.05.001

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…If we started with the patient, and worked backward, we likely would not develop a system in which continuity of care was the rare exception. The literature is not definitive, but studies suggest that increased continuity of care is associated with improved patient satisfaction, 5-8 increased trainee humanism and satisfaction, [9][10][11][12] and enhanced patient outcomes. [13][14][15][16] Decreasing continuity is often associated with the opposite findings.…”

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confidence: 99%

Continuity—Working Backward From the Patient

Warm

2016

Journal of Graduate Medical Education

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confidence: 99%

Continuity—Working Backward From the Patient

Warm

2016

Journal of Graduate Medical Education

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“…24 In Calgary CTUs, senior residents do not engage in overnight on-call duties and, therefore, avoid off-duty post-call days to help ensure continuity of patient care. 25 Only one of the three included hospitals had regularly scheduled day-time senior residents. The presence of senior residents does not alter the patient mix or admitting process.…”

Section: Settingmentioning

confidence: 99%

Association Between Health System Factors and Utilization of Routine Laboratory Tests in Clinical Teaching Units: a Cohort Analysis

2021

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BACKGROUND: Few studies have looked at health system factors associated with laboratory test use. OBJECTIVE: To determine the association between health system factors and routine laboratory test use in medical inpatients. DESIGN: We conducted a retrospective cohort study on adult patients admitted to clinical teaching units over a 3year period (January 2015 to December 2017) at three tertiary care hospitals in Calgary, Alberta. PARTICIPANTS: Patients were assigned to a Case Mix Group+ (CMG+) category based on their clinical characteristics, and patients in the top 10 CMG+ groups were included in the cohort. EXPOSURES: The examined health system factors were (1) number of primary attending physicians seen by a patient, (2) number of attending medical teams seen by a patient, (3) structure of the medical team, and (4) day of the week. MAIN MEASURES: The primary outcome was the total number of routine laboratory tests ordered on a patient during their admission. Statistical models were adjusted for age, sex, length of stay, Charlson comorbidity index, and CMG+ group. RESULTS: The final cohort consisting of 36,667 patientdays in hospital (mean (SD) age 62.5 (18.4) years) represented 5071 unique hospitalizations and 4324 unique patients. Routine laboratory test use was increased when patients saw multiple attending physicians; with an adjusted incidence rate ratio (IRR) of 1.46 (95% CI, 1.37-1.55) for two attending physicians, and 2.50 (95% CI, 2.23-2.79) for three or more attending physicians compared to a single attending physician. The number of routine laboratory tests was slightly lower on weekends (IRR 0.98, 95% CI, 0.96-0.99) and on teams without a senior resident as part of their team structure (IRR 0.89, 95% CI 0.830.96). CONCLUSIONS:The associations observed in this study suggest that breaks in continuity of care, including increased frequency in patient transfer of care, may impact the utilization of routine laboratory tests.

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A 15-year review of the Stanford Internal Medicine Residency Program: predictors of resident satisfaction and dissatisfaction

Kahn

Witteles²,

Mahaffey

et al. 2017

AMEP

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IntroductionSatisfaction with training and with educational experiences represents important internal medicine (IM) programmatic goals. Graduates from IM residency programs are uniquely poised to provide insights into their educational and training experiences and to assess whether these experiences were satisfactory and relevant to their current employment.MethodsWe surveyed former IM residents from the training program held during the years 2000–2015 at the Department of Medicine, Stanford University. The first part of the survey reviewed the IM residency program and the second part sought identifying data regarding gender, race, ethnicity, work, relationships, and financial matters. The primary outcome was satisfaction with the residency experience.ResultsOf the 405 individuals who completed the Stanford IM residency program in the study period, we identified 384 (95%) former residents with a known email address. Two hundred and one (52%) former residents responded to the first part and 185 (48%) answered both the parts of the survey. The mean age of the respondents was 36.9 years; 44% were female and the mean time from IM residency was 6.1 (±4.3) years. Fifty-eight percent reported extreme satisfaction with their IM residency experience. Predictors associated with being less than extremely satisfied included insufficient outpatient experience, insufficient international experience, insufficient clinical research experience, and insufficient time spent with family and peers.ConclusionThe residents expressed an overall high satisfaction rate with their IM training. The survey results provided insights for improving satisfaction with IM residency training that includes diversifying and broadening IM training experiences.

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An observational pre–post study of re-structuring Medicine inpatient teaching service: Improved continuity of care within constraint of 2011 duty hours

Cited by 3 publications

References 18 publications

Continuity—Working Backward From the Patient

Continuity—Working Backward From the Patient

Association Between Health System Factors and Utilization of Routine Laboratory Tests in Clinical Teaching Units: a Cohort Analysis

A 15-year review of the Stanford Internal Medicine Residency Program: predictors of resident satisfaction and dissatisfaction

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