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What do patients think about year-end resident continuity clinic handoffs? A qualitative study.

ABSTRACT: BACKGROUND: Although Internal Medicine year-end resident clinic handoffs affect numerous patients, little research has described patients' perspectives of the experience. OBJECTIVE: To describe patients' perceptions of positive and negative experiences pertaining to the year-end clinic handoff; to rate patient satisfaction with aspects of the clinic handoff and identify whether or not patients could name their new physicians. DESIGN: Qualitative study design using semi-structured interviews. PARTICIPANTS: High-risk patients who underwent a year-end clinic handoff in July 2011. MEASUREMENTS: Three months post-handoff, telephone interviews were conducted with patients to elicit their perceptions of positive and negative experiences. An initial coding classification was developed and applied to transcripts. Patients were also asked to name their primary care physician (PCP) and rate their satisfaction with the handoff. RESULTS: In all, 103 telephone interviews were completed. Patient experiences regarding clinic handoffs were categorized into four themes: (1) doctor-patient relationships (i.e. difficulty building rapport); (2) clinic logistics (i.e. difficulty rescheduling appointments); (3) process of the care transition (i.e. patient unaware transition occurred); and (4) patient safety-related issues (i.e. missed tests). Only 59 % of patients could correctly name their new PCP. Patients who reported that they were informed of the clinic transition by letter or by telephone call from their new PCP were more likely to correctly name them (65 % vs. 32 % p?=?0.007), report that their new doctor assumed care for them immediately (81 % [68/84] vs. 53 % [10/19], p?=?0.009) and report satisfaction with communication between their old and new doctors (80 % [67/84] vs. 58 % [11/19], p?=?0.04). Patients reported positive experiences such as learning more about their new physician through personal sharing, which helped them build rapport. Patients who reported being aware of the medical education mission of the clinic tended to be more understanding of the handoff process. CONCLUSIONS: Patients face unique challenges during year-end clinic handoffs and provide insights into areas of improvement for a patient-centered handoff.

SUBMITTER: Pincavage AT

PROVIDER: S-EPMC3710383 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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What do patients think about year-end resident continuity clinic handoffs? A qualitative study.

Pincavage Amber T AT Lee Wei Wei WW Beiting Kimberly J KJ Arora Vineet M VM

Journal of general internal medicine 20130801 8

<h4>Background</h4>Although Internal Medicine year-end resident clinic handoffs affect numerous patients, little research has described patients' perspectives of the experience.<h4>Objective</h4>To describe patients' perceptions of positive and negative experiences pertaining to the year-end clinic handoff; to rate patient satisfaction with aspects of the clinic handoff and identify whether or not patients could name their new physicians.<h4>Design</h4>Qualitative study design using semi-structu ...[more]

PMID: 23595932

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Project description:BACKGROUND: Fewer residents are choosing general internal medicine (GIM) careers, and their choice 5 be influenced by the continuity clinic experience during residency. We sought to explore the relationship between resident satisfaction with the continuity clinic experience and expressed interest in pursuing a GIM career. METHODS: We surveyed internal medicine residents by using the Veterans Health Administration Office of Academic Affiliations Learners' Perceptions Survey-a 76-item instrument with established reliability and validity that measures satisfaction with faculty interactions, and learning, working, clinical, and physical environments, and personal experience. We identified 15 reliable subscales within the survey and asked participants whether their experience would prompt them to consider future employment opportunities in GIM. We examined the association between satisfaction measures and future GIM interest with 1-way analyses of variance followed by Student-Newman-Keuls post hoc tests. RESULTS: Of 217 residents, 90 (41%) completed the survey. Residents felt continuity clinic influenced career choice, with 22% more likely to choose a GIM career and 43% less likely. Those more likely to choose a GIM career had higher satisfaction with the learning (P = .001) and clinical (P = .002) environments and personal experience (P < .001). They also had higher satisfaction with learning processes (P = .002), patient diversity (P < .001), coordination of care (P = .009), workflow (P = .001), professional/personal satisfaction (P < .001), and work/life balance (P < .001). CONCLUSIONS: The continuity clinic experience 5 influence residents' GIM career choice. Residents who indicate they are more likely to pursue GIM based on that clinical experience have higher levels of satisfaction. Further prospective data are needed to assess if changes in continuity clinic toward these particular factors can enhance career choice.

Project description:BackgroundHandoff education is both formal and informal and varies widely across medical school and residency training programs. Despite many efforts to improve clinical handoffs, little evidence has shown meaningful improvement. The objective of this study was to identify residents' perspectives and develop a deeper understanding on the necessary training to conduct safe and effective patient handoffs.MethodsA qualitative study focused on the analysis of cognitive task interviews targeting end-of-shift handoff experiences with 35 residents from three geographically dispersed VA facilities. The interview data were analyzed using an iterative, consensus-based team approach. Researchers discussed and agreed on code definitions and corresponding case examples. Grounded theory was used to analyze the transcripts.ResultsAlthough some residents report receiving formal training in conducting handoffs (e.g., medical school coursework, resident boot camp/workshops, and handoff debriefing), many residents reported that they were only partially prepared for enacting them as interns. Experiential, practice-based learning (i.e., giving handoffs, covering night shift to match common issues to handoff content) was identified as the most suited and beneficial for delivering effective handoff training. Six skills were described as critical to learning effective handoffs: identifying pertinent information, providing anticipatory guidance, applying acquired clinical knowledge, being concise, incorporating delivery strategies, and appreciating the styles/preferences of handoff recipients.ConclusionsResidents identified the immersive performance and the experience of covering night shifts as the most important aspects of learning to execute effective handoffs. Formal education alone can miss the critical role of real-time sense-making throughout the process of handing off from one trainee to another. Interventions targeting senior resident mentoring and night shift could positively influence the cognitive and performance capacity for safe, effective handoffs.

Dataset Information

What do patients think about year-end resident continuity clinic handoffs? A qualitative study.

Publications

What do patients think about year-end resident continuity clinic handoffs? A qualitative study.

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