Top

Published in:

01-12-2016 | Original Research

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

Authors: Eric Young, MD, Chad Stickrath, MD, Monica C. McNulty, MS, Aaron J. Calderon, MD, Elizabeth Chapman, MD, Jed D. Gonzalo, MD, MSc, Ethan F. Kuperman, MD, MS, Max Lopez, MD, Christopher J. Smith, MD, Joseph R. Sweigart, MD, Cecelia N. Theobald, MD, MPH, Robert E. Burke, MD, MS

Published in: Journal of General Internal Medicine | Issue 12/2016

Abstract

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.

Available only for authorised users

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418–28.CrossRefPubMed

Joynt KE, Jha AK. A path forward on Medicare readmissions. N Engl J Med. 2013;368(13):1175–7.CrossRefPubMed

Davis M, Devoe M, Kansagara D, Nicolaidis C, Englander H. “Did I do as best as the system would let me?” Healthcare professional views on hospital to home care transitions. J Gen Intern Med. 2012;27(12):1649–56.CrossRefPubMedPubMedCentral

Jones CD, Vu MB, O’Donnell CM, et al. A failure to communicate: A qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations. J Gen Intern Med. 2015;30(4):417–24.CrossRefPubMed

Burke RE, Ryan P. Postdischarge clinics: Hospitalist attitudes and experiences. J Hosp Med. 2013;8(10):578–81.CrossRefPubMed

Arora VM, Prochaska ML, Farnan JM, et al. Problems after discharge and understanding of communication with their PCPs among hospitalized seniors: A mixed methods study. J Hosp Med. 2010;5(7):385–91.CrossRefPubMedPubMedCentral

Snow V, Beck D, Budnitz T, et al. Transitions of care consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine. J Hosp Med. 2009;4(6):364–70.CrossRefPubMed

Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211.CrossRef

Chen C, Petterson S, Phillips R, Bazemore A, Mullan F. Spending patterns in region of residency training and subsequent expenditures for care provided by practicing physicians for medicare beneficiaries. JAMA. 2014;312(22):2385–93.CrossRefPubMed

10.

Papadakis MA, Teherani A, Banach MA, et al. Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med. 2005;353(25):2673–82.CrossRefPubMed

11.

Greysen SR, Schiliro D, Horwitz LI, Curry L, Bradley EH. “Out of sight, out of mind”: Housestaff perceptions of quality-limiting factors in discharge care at teaching hospitals. J Hosp Med. 2012;7(5):376–81.CrossRefPubMedPubMedCentral

12.

Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the Hospital. Ann Intern Med. 2003;138(3):161–7.CrossRefPubMed

13.

Roy CL, Poon EG, Karson AS, et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005;143(2):121–8.CrossRefPubMed

14.

Dalal AK, Roy CL, Poon EG, et al. Impact of an automated email notification system for results of tests pending at discharge: A cluster-randomized controlled trial. J Am Med Inform Assoc. 2014;21(3):473–80.CrossRefPubMed

15.

Misky GJ, Wald HL, Coleman EA. Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up. J Hosp Med. 2010;5(7):392–7.CrossRefPubMed

16.

Hernandez AF, Greiner MA, Fonarow GC, et al. Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA. 2010;303(17):1716–22.CrossRefPubMed

17.

Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, et al. Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41.CrossRefPubMed

18.

Greenwald JL, Halasyamani L, Greene J, et al. Making inpatient medication reconciliation patient centered, clinically relevant and implementable: A consensus statement on key principles and necessary first steps. J Hosp Med. 2010;5(8):477–85.CrossRefPubMed

19.

West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med. 2009;24(12):1318–21.CrossRefPubMedPubMedCentral

20.

Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355–63.CrossRefPubMedPubMedCentral

21.

Beresford L. Hospitalists’ responsibility, role in readmission prevention. Hospitalist. 2015;19(4):1.

22.

Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73(4):403–7.CrossRefPubMed

23.

Pinelli VA, Papp KK, Gonzalo JD. Interprofessional communication patterns during patient discharges: A social network analysis. J Gen Intern Med. 2015;30(9):1299–306.CrossRefPubMedPubMedCentral

24.

Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422.CrossRefPubMed

25.

Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: A review of key issues for hospitalists. J Hosp Med. 2007;2(5):314–23.CrossRefPubMed

26.

Auerbach AD, Kripalani S, Vasilevskis EE, et al. Preventability and causes of readmissions in a national cohort of general medicine patients. JAMA Intern Med. 2016;176(4):484–93.CrossRefPubMed

27.

Bell CM, Schnipper JL, Auerbach AD, et al. Association of communication between hospital-based physicians and primary care providers with patient outcomes. J Gen Intern Med. 2009;24(3):381–6.CrossRefPubMed

28.

Campbell J, Prochazka AV, Yamashita T, Gopal R. Predictors of persistent burnout in internal medicine residents: A prospective cohort study. Acad Med. 2010;85(10):1630–4.CrossRefPubMed

Title: Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey
Authors: Eric Young, MD
Chad Stickrath, MD
Monica C. McNulty, MS
Aaron J. Calderon, MD
Elizabeth Chapman, MD
Jed D. Gonzalo, MD, MSc
Ethan F. Kuperman, MD, MS
Max Lopez, MD
Christopher J. Smith, MD
Joseph R. Sweigart, MD
Cecelia N. Theobald, MD, MPH
Robert E. Burke, MD, MS
Publication date: 01-12-2016
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 12/2016
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-016-3855-3

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Background

Objective

Design

Participants

Main Measures

Key Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Objective

Design

Participants

Main Measures

Key Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2016

Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study

Patient-Centered Medical Home Implementation in the Veterans Health Administration and Primary Care Use: Differences by Patient Comorbidity Burden

Capsule Commentary on Wolf et al., A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

Capsule Commentary of Shah et al., Targeted Reminder Phone Calls to Patients at High Risk to No-Show for Primary Care Appointment: A Randomized Trial

Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page