From the University of Pittsburgh Medical Center, and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
South Med J. 2022 Jan;115(1):18-21. doi: 10.14423/SMJ.0000000000001341.
Hospital discharge is a challenging time for residents, requiring the completion of many tasks to ensure safe transitions for patients. Despite recognition of the importance of hospital discharge planning, formal curricula are lacking. We sought to improve medicine residents' comfort and skills with discharge planning and enhance the quality of care by introducing a standardized approach to discharge on the medicine wards.
The intervention included a didactic, a bedside rounds component, and a discharge checklist. Interns were surveyed at the end of rotations to measure confidence, attitudes, and frequency of completing discharge planning tasks. Results were compared with a control group of experienced interns from the previous academic year. Clinical outcomes included hospital readmission and emergency department return rates and patient satisfaction scores in discharge-related domains.
Study interns reported similar confidence to control group interns with discharge planning and endorsed completing four of five discharge tasks more frequently than control interns. There were no differences in clinical outcomes.
We did not identify changes in clinical outcomes, although this finding likely reflects the multifactorial nature of hospital readmissions. Interns exposed to the curriculum early in the academic year had a higher reported frequency of completing key discharge tasks and similar confidence around discharge, when compared with end-of-the-year interns. These improvements suggest that the curriculum led to a change in culture surrounding discharge planning and perhaps accelerated learning of skills associated with discharge best practices.
医院出院对住院医师来说是一个具有挑战性的时刻，需要完成许多任务，以确保患者安全过渡。尽管人们认识到出院计划的重要性，但缺乏正式的课程。我们试图通过在内科病房引入标准化的出院方法，提高住院医师在出院计划方面的舒适度和技能，并提高护理质量。
干预措施包括一个讲座、床边查房部分和一个出院清单。在轮转结束时，对实习医生进行调查，以衡量他们在出院计划方面的信心、态度和完成任务的频率。结果与上一学年有经验的实习医生的对照组进行了比较。临床结果包括住院患者再入院率和急诊科返回率以及与出院相关领域的患者满意度评分。
研究组实习医生报告的出院计划信心与对照组实习医生相似，并表示比对照组实习医生更频繁地完成五项出院任务中的四项。临床结果没有差异。
我们没有发现临床结果的变化，尽管这一发现可能反映了医院再入院的多因素性质。在学术年初接触课程的实习医生在完成关键出院任务的报告频率和出院方面的信心方面，与年终实习医生相比更高。这些改进表明，课程改变了围绕出院计划的文化，也许加速了与出院最佳实践相关的技能学习。
