McBryde Meagan, Vandiver Jeremy W, Onysko Mary
Swedish Family Medicine Residency Program, Littleton, CO.
Fam Med. 2016 Apr;48(4):265-72.
Transitioning patients safely from the inpatient environment back to an outpatient environment is an important component of health care, and multidisciplinary cooperation and formal processes are necessary to accomplish this task. This Transitions of Care (TOC) process is constantly being shaped in health care systems to improve patient safety, outcomes, and satisfaction. While there are many models that have been published on methods to improve the TOC process systematically, there is no clear roadmap for educators to teach TOC concepts to providers in training. This article reviews published data to highlight specific methods shown to effectively instill these concepts and values into medical students and residents. Formal, evidence-based, TOC curriculum should be developed within medical schools and residency programs. TOC education should ideally begin early in the education process, and its importance should be reiterated throughout the curriculum longitudinally. Curriculum should have a specific focus on recognition of common causes of hospital readmissions, such as medication errors, lack of adequate follow-up visits, and social/economic barriers. Use of didactic lectures, case-based workshops, role-playing activities, home visits, interprofessional activities, and resident-led quality improvement projects have all be shown to be effective ways to teach TOC concepts.
让患者安全地从住院环境过渡到门诊环境是医疗保健的一个重要组成部分,而多学科合作和正规流程对于完成这项任务是必要的。这种护理过渡(TOC)流程在医疗保健系统中不断形成,以提高患者安全性、改善治疗结果并提升满意度。虽然已经发表了许多关于系统改进TOC流程方法的模型,但对于教育工作者而言,并没有明确的路线图来向实习医生传授TOC概念。本文回顾已发表的数据,以突出显示那些被证明能有效地将这些概念和价值观灌输给医学生和住院医生的具体方法。医学院校和住院医师培训项目应制定正规的、基于证据的TOC课程。TOC教育理想情况下应在教育过程早期开始,并且其重要性应在整个课程中纵向反复强调。课程应特别关注识别医院再入院的常见原因,例如用药错误、缺乏充分的随访以及社会/经济障碍。使用讲授式讲座、基于案例的研讨会、角色扮演活动、家访、跨专业活动以及住院医生主导的质量改进项目,都已被证明是教授TOC概念的有效方法。