Background: Residents typically learn about managing transitions of care as part of the informal curriculum in an ad-hoc, reactive manner. Learning may be enhanced by using a framework to proactively practice addressing key domains for a patient soon-to-be-discharged from the hospital. We developed such an evidence-based framework, DISCHARGE , as a cognitive aid. Using this framework, we implemented and evaluated a workshop designed for hospital teams to learn addressing key components of discharging a patient.
Methods: All members of 8 Internal Medicine teams across 4 rotations were invited to attend an hour-long workshop ranging from September 2017 - February 2018. Participants completed a retrospective, pre-post survey on their perceived change in discharge-related behaviors. We evaluated the perceived effectiveness of the workshop with a retrospective pre-post questionnaire. We used Wilcoxon signed-rank tests for pairwise comparisons to access perceived changes in discharge behaviors.
Results: A total of 90 of 140 team members (64%) attended the workshop and 79 of the 90 (87%) completed the questionnaire. The session was effective in increasing the likelihood of addressing patient-centered behaviors at discharge (mean 1.4 improvement on a 5-point scale, P<0.001, R>0.5). In addition, senior residents and attendings projected they were more likely to discuss the importance of discharge planning with the team early in a rotation. Interns noted they were more comfortable asking the team for help in carrying out a discharge plan (p<0.001, R>0.5).
Conclusions: Teaching teams a cognitive aid to practice managing hospital discharges may increase the likelihood of addressing important domains for their patients. Incorporating the team allows for explicit alignment for priorities and communication. Further study is needed to document how such learning is translated into discharge practice.