Why Teach About Hospital Discharge?
ACGME Milestones are mapped to the broad skill sets residents need to learn how to transition a patient from the hospital to home or a second facility. So this is a learning target for our residencies.
Beyond that, consider: a safe and effective discharge improves patient care, patient safety and hospital care value. Up to 3/4 of hospital readmissions are considered preventable; 19-23% suffer an adverse event on hospital discharge that is preventable.
In addition, learning to transition patients trains a resident in usable skills for many other medical situations. Assessing barriers, training a patient in self care and recognizing when the interprofessional care team is needed are just a few.
Transition Slide Deck
Use this slide deck to find an overview and teaching points to build the a rationale for Effective Transitions.
Review this article that highlights why physicians in training need an awareness of the things that can go wrong on transition from the hospital.Transitions Article
How will you build a rationale for residents on your team to learn how to transition patients well?
How comfortable are you in giving feedback to a resident who appears unaware that a patient has serious barriers to discharge?
Which aspects of a Discharge Summary might be most challenging for a an inexperienced resident? What pointers would you give?
How can I add teaching about transitions?
Our faculty thought about this at a recent faculty development session. They decided that sharing data highlighting the dangers of failed transitions can build the rationale in a resident's thinking for becoming competent in discharge. Letting them carry out one of the key activities of discharge while you observe and give feedback is a powerful way to train these skills. Solving problems on work rounds together and connecting actions to addressing readmission is another.
What are the elemEnts of an effective discharge?
Our faculty have identified 7 key elements of a good discharge:
1. Confirm the PCP who will follow up and set an appointment time; start TCM process for a transition appointment in IMC.
2. Update the Diagnosis and Follow Up Plan/Discharge Date.
3. Reconcile Meds: train patient and family for adherence
4. Train Patient/Family for Self Care: Use Zone Education to limit learning points.
5. Assess Risks/Barriers (Geisinger scale > 14)
6. Clarify consultant tasks after discharge (Communicate!)
7. Document hospital stay in Discharge Summary (be concise, include reasoning, and an outpatient To Do list.