“Did I Do as Best as the System Would Let Me?” Healthcare Professional Views on Hospital to Home Care Transitions

Davis, Melinda M.; Devoe, Meg; Kansagara, Devan; Nicolaidis, Christina; Englander, Honora

doi:10.1007/s11606-012-2169-3

Cited by 92 publications

(96 citation statements)

References 29 publications

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“…First, we utilized a single question derived from prior work in this area to assess the perceived duration of post-discharge responsibility (BHow many days are inpatient providers responsible for their patients after they are discharged?^). 5 To further explore the content of responsibility, we developed specific questions to assess residents' perceived responsibility within four key domains in transitions of care: (1) medication reconciliation, 12 (2) lab follow-up, 13,14 (3) postdischarge follow-up appointments, 15,16 and (4) communication with outpatient providers 17 . Within each of these domains, one question was developed to assess residents' perceived responsibility for discharge practices currently considered the standard of care based on consensus policy statements from multiple large professional societies 7,18 (e.g., BAs an inpatient provider, I am responsible for ensuring that labs pending at the time discharge are accurately documented in my discharge summary^).…”

Section: Survey Instrumentmentioning

confidence: 99%

“…Therefore, we used expert opinion and relevant qualitative data 3,11 to iteratively decide upon nine factors that we believed might correlate with perceived post-discharge responsibility. Post-graduate year, participation in a community-based versus university-based program, and anticipated career path were assessed based on demographic questions.…”

Section: Survey Instrumentmentioning

confidence: 99%

“…20 Finally, residents were asked to rank the impact of six potential barriers to ensuring successful transitions of care derived from expert opinion and prior qualitative studies. 3,4,11 …”

Section: Survey Instrumentmentioning

confidence: 99%

“…1,2 Despite financial incentives and growing attention from the medical community, significant inter-provider variability exists with regard to perceived responsibility in the post-discharge period. 3,4 A recent study of practicing hospitalists found that 29 % believed their responsibility for patients ended at the time of discharge, while 26 % believed their responsibility extended beyond 2 weeks. 5 Primary care providers express similar variability regarding the timing and content of their responsibility for patients after discharge.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 However, the literature currently offers limited insight into medical residents' attitudes towards transitions of care. 3,11 . We sought to examine the duration and content internal medicine residents' perceived post-discharge responsibility and determine whether specific individual characteristics and experiences correlate with perceived responsibility.…”

Section: Introductionmentioning

confidence: 99%

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Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey

et al. 2016

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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.

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Section: Survey Instrumentmentioning

confidence: 99%

Section: Survey Instrumentmentioning

confidence: 99%

“…20 Finally, residents were asked to rank the impact of six potential barriers to ensuring successful transitions of care derived from expert opinion and prior qualitative studies. 3,4,11 …”

Section: Survey Instrumentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey

et al. 2016

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Transitions of Care: Putting the Pieces Together

Kansagara

Chan²,

Harmon³

et al. 2013

AMA Journal of Ethics

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Nurses' experiences of transitions of older patients from hospitals to community care. A nation‐wide survey in Norway

Gautun¹,

Bratt

Billings

2020

Health Science Reports

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Background and Aims Moving older patients from hospitals to community services is a critical phase of integrated care. Yet, large‐scale research on the quality of these transitions has been missing. Consequently, it has been difficult to assess to what extent and how patient transitions need to be improved. The purpose of this research was to gather the perspective of nurses involved in the transition of older patients (defined as patients 65 years or older) in Norway. Methods Data were collected in 2017 among Norwegian nurses with two nationwide web‐based surveys, one among nurses working at in‐patient wards in acute hospitals, and another among nurses in home nursing and nursing homes in the community. We sent emails to all nurses who were members of the Norwegian Nurses Organisation (NSS), where most Norwegian nurses are organised. The email included a recommendation by the NSS. Instructions in the email and the online questionnaire ensured that only nurses involved in the transition of older patients participated. The online questionnaire assessed nurses' evaluations of the quality of patient transitions and information exchange between the services involved in patient transitions. Results 4312 nurses working in community care services and 2421 nurses at in‐patient wards at hospitals responded. Both groups were predominantly female (94%), and nearly 90% of Norway's 428 municipalities were included in the study. Compared to hospital nurses, the nurses working in community care experienced lower quality of patient transitions and were less satisfied with the information exchange on patients' condition and needs. Further, when comparing groups of community nurses, we found that nurses in home nursing were more dissatisfied with the quality of transitions and information exchange than nurses in nursing homes. Conclusion We conclude that hospital nurses should have more face‐to‐face or telephone contact with community nurses, and specifically with home nurses. Further, we suggest promoting a mutual understanding of the older patients' pathway from one service to the other, and to improve co‐ordination across the services. We suggest that one means to achieve such improvements is to use multi‐disciplinary discharge teams, while another is to develop case management or care navigator roles specific to the discharge process.

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“Did I Do as Best as the System Would Let Me?” Healthcare Professional Views on Hospital to Home Care Transitions

Cited by 92 publications

References 29 publications

Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey

Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey

Transitions of Care: Putting the Pieces Together

Nurses' experiences of transitions of older patients from hospitals to community care. A nation‐wide survey in Norway

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