Handover and Care Transitions Training for Internal Medicine Residents
Emory University School of Medicine
Peer reviewed
The presentations and exercises in this resource are intended to serve as introductory training tools for interns and residents for them to better perform care transitions. In this context, care transitions are defined as “the movement patients make between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness” (Care Transitions Program, http://caretransitions.org). For our training exercises, we have focused on two types of transitions: handovers of patients between hospital providers, as well as hospital discharges.
In this resource, we have two different training experiences offered to internal medicine interns and residents at the Emory University School of Medicine: a two-hour workshop on care transitions issues offered to interns during their initial orientation, as well as an interactive presentation given to all residents a month into the academic year.
After completing the course, learners should be able to:
- Identify what patient information should be included at handover.
- Communicate the essential elements of a nightly handover.
- Recognize patients at risk during transitions of care.
- Communicate clearly with patients and families, and members of the health care team during hospital discharge.
- Manage discharge medications to ensure safety and patient adherence.
Effectiveness and Significance
The enclosed learning materials are part of a comprehensive curriculum for internal medicine interns and residents addressing care transitions in the hospital. It specifically covers handovers of patients in the hospital, as well as issues regarding patient care at discharge.
On the first implementation of this curriculum during the 2010-2011 academic year, the interns receiving the initial orientation gave the course a 4.1/5 in terms of perceived effectiveness. Interns’ confidence in their ability to perform care transitions tasks improved from 19.8 to 25.7 on a 30-point scale (p<0.0001), and knowledge scores improved from 4.5 to 5.7 out of 8 (p<0.0001), from pre- to post-course. After the course, 79% (34 of 43) answered “agree” or “strongly agree” when asked whether the course played a key role in their ability to hand over patients. 67% (29 of 43) answered “agree” or “strongly agree” when asked the same question about their ability to discharge patients.
This was the first dedicated curriculum on handovers or care transitions for medical residents at the Emory University School of Medicine. The lectures and exercises included in this resource are the core of a longitudinal care transitions curriculum that is now part of Emory's internal medicine training program.
Special Implementation Guidelines or Requirements
The materials contained in this package are meant to help with training of internal medicine (or family medicine) interns and residents on issues surrounding care transitions. The files attached were utilized for two distinct sessions: a two-hour session during the weeklong intern orientation, as well as an hourlong core lecture given a month later for the entire class of PGY 1-3 in Medicine.
Implementation of Intern Orientation
Detailed instructions on how to implement the exercises involved in intern orientation are in the attached documents. About two hours would be required for the exercise. Forty-five minutes would be used for the initial slide presentation, and about one hour would be used for the small group exercises. The handover and discharge summary exercises should be carried out dividing the larger class into groups of no more ten interns. The number of faculty required for this exercise will depend on the size of the intern class.
Core Lecture
The lecture can be given by one faculty member in a conference room. There is no predetermined limit on class size, as the interactive parts can be performed by asking residents to work in pairs and then having a discussion with the larger group.
The first document we recommend reading is facilitator_guide.doc, which contains instructions for both sessions.
Lessons Learned
We have received encouraging feedback for our training sessions on care transitions. The most important challenge we've worked with has been the integration of the lessons learned in the course into daily clinical practice. Our on care transitions transitions is very skills-oriented, so we needed to work with the faculty and administration at our different clinical sites to make sure that the skills our residents were learning were able to be integrated into clinical practice.