News and Commentary Macy Faculty Scholar Lauren Meade on Hospital Discharge Training

Lauren Meade, MD, of Tufts University Medical School discusses her new interprofessional course focused on care transitions.

What are you working on as a Macy Faculty Scholar?

As a Macy Faculty Scholar I am developing a new competency-based curriculum focused on providing safe and effective hospital discharges.

The transition of care is such a critical time for patients. During this time health professionals must work as a team. My project will help physicians-in-training better understand what needs to happen as patients transition from the hospital to their next setting, as well as teach skills necessary for interprofessional collaboration and communication within and outside the hospital system.

Why focus on care transitions?
In my early career I was a primary care provider, hospitalist and a clinical educator dedicated to helping residents become competent. My primary care site was an inner city academic health center where I cared for diverse populations who needed a lot from the healthcare system. I chose as my first project to organize and care for our 200 HIV patients by developing what we now call a patient centered medical home model. I got funding to use a team-based approach to treat the patients and saw some very promising results. It was through this type of work that I started to see the power of team-based care and understand how critical care transitions can be for many patients.

I chose transitions as an area of focus because it is so rich in teamwork opportunities. We must do a better job of training doctors to work effectively within teams and transitional care is a perfect place to do it. Transitions education is relatively new, but the safety world has already identified it as an important place to focus on improving patient safety.

How will you measure competency?
In the fall of 2013 we launched a study in 12 internal medicine programs to enhance the training of physicians in the transitions of care. The tool for this study was developed by focus groups of patients, nurses, learners and teachers. We asked the healthcare team to tell us what doctor behaviors are meaningful and most effective to ensure a safe discharge from the hospital.

We used this information to identify six milestone skills for physician discharge behaviors. These milestones will be used to assess residents by faculty directly observing residents acquire these skill sets. When the resident is determined competent, the faculty can step back and give the residents more autonomy. Faculty will teach the skills, know that it was taught correctly and move onto the next set of skills. This real-time learning will ensure patients stay safe and are discharged effectively, and will allow faculty to give more accurate and timely feedback.

What milestones will you be looking at?
Currently, trainees don’t have adequate training in team collaboration and communication, which is two of the six milestones that we are going to look at.

Another milestone area is medication reconciliation. When a patient is going to be discharged from the hospital the physician should know what medications that patient came in on and what medication changes are being made when that patient goes home. The physician also needs to know how realistic the prescribed medications are for the patient (i.e. in terms of cost and being able to obtain the drugs). These are all complex competencies even for those faculty who are experts in the transition of care.

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