Abstract
Objectives
Prior studies have found suboptimal knowledge about post-acute care (PAC) among inpatient
providers and poor communication at discharge that can lead to unsafe discharge transitions,
but little is known about residents and the PAC transition. The aim of this study
is to assess internal medicine residents’ knowledge, attitudes, and current practice
regarding patient transitions to PAC.
Design
A multisite, cross-sectional 36-question survey.
Setting and Participants
Internal Medicine and Medicine-Pediatrics residents at 3 university-based Internal
Medicine training programs in the United States. Methods: Survey delivered electronically to residents in 2018 and 2019. Survey responses
were described by collapsing 4-point Likert responses into dichotomous variables,
and thematic content analysis was used to evaluate free text responses. Results: Of 482 residents surveyed, 236 responded (49%). Despite high reported confidence
in their ability to transition patients to PAC, only 31% of residents knew how often
patients received skilled therapies at skilled nursing facilities (SNFs) and 23% knew
how frequently nursing services are provided. The majority of residents (79%) identified
the discharge summary as the main way they communicated care instructions to the SNF,
but only 55% reported always completing it prior to discharge. Upper-level residents
were more likely to know how much therapy patients received at a SNF, but resident
knowledge about PAC did not vary by residency year in other domains. Residents who
experienced a clinical rotation at a SNF had higher levels of knowledge compared to
residents who did not.
Conclusions
This national survey of internal medicine residents identified common knowledge gaps
regarding PAC. These knowledge gaps did not improve throughout residency without deliberate
exposure to PAC environments. This suggests a need for dedicated curriculum development
as discharges to PAC continue to rise exponentially.
Keywords
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Article info
Publication history
Published online: March 19, 2021
Footnotes
Dr Jones' work was supported by Agency for Healthcare Research and Quality Career Development Award (Award 1K08HS024569).
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
