Abstract: SA-PO195
Differing Expectations of Transitions of Care Within a Nephrology Practice: Should We Transition to Train More?
Session Information
- Educational Research
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Educational Research
- 800 Educational Research
Authors
- Alagusundaramoorthy, Sayee Sundar, University of Wisconsin, Madison, Wisconsin, United States
- Strennen, Samantha J., University of Wisconsin-Madison, Madison, Wisconsin, United States
- Maursetter, Laura J., University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
- Bhutani, Gauri, University of Wisconsin, Madison, Wisconsin, United States
Background
Ineffective transitions of care (TOC) communication is a major contributing factor to medical errors.
Methods
As part of an endeavor to standardize TOC practice in our division, we conducted a two-step survey-based study of TOC perceptions among faculty and fellows over the last one year. Data was collected anonymously via two different electronic surveys. The first (Survey1) focused on providers’ perceptions of the TOC practice in the division. The second (Survey2) asked for a self-assessment about providers’ own TOC procedure. Fisher’s exact test was used for statistical analysis of the survey results.
Results
Attendings were significantly less satisfied with the current division TOC practice as compared to fellows (table). Both attendings and fellows appeared equally satisfied with their own TOC methods. APP response fell between physician and fellow responses for most questions. Most faculty (71%) and fellow (66.7%) responses indicated they would prefer changes in current TOC practice.
Conclusion
Our results reveal a gap between TOC expectations and self-reflection amongst faculty and fellows in one division. This may reflect a lack of formal training to align expectations in TOC practice. The general acceptance of the division TOC environment by fellows likely stems from the fact that the majority of TOC documentation is done by this group. Overall, most providers were interested in changes to improve TOC practices. We plan on step-wise changes including instituting a standardized division TOC policy, EMR support, formal training in TOC, and continuing assessment of TOC practice and environment in the division.
| Physician (%) | Advanced Practice Provider (APP; %) | Fellow (%) | P-value | |
| Survey1 respondents | 75% (12/16) | 75% (6/8) | 83.3% (5/6) | |
| Always satisfied with weekend call sign-out received ? | 0% (0/9) | NA | 100% (5/5) | <.001 |
| Mostly satisfied with weekend call sign-out received ? | 55.6% (5/9) | NA | NA | NA |
| Felt patient safety compromised due to lack of appropriate TOC ? | 41.75% (5/12) | 33.3% (2/6) | 0% (0/5) | 0.298 |
| I have adequate time to provide sign out ? | 83.3 % [10/12] | 100% (5/5) | 80% (4/5) | 1.000 |
| TOC is always valued in our Division ? | 16.7% (2/12) | 0% (0/6) | 100% (5/5) | <.001 |
| Survey2 respondents | 81.3% (13/16) | 77.8% (7/9) | 67% (4/6) | |
| I am always satisfied with the sign-outs that I provide | 23% (3/13) | 0% (0/7) | 50% (2/4) | 0.376 |
| I am mostly satisfied with the sign-outs that I provide | 61.5% (8/13) | 85% (6/7) | 25% (1/4) | 0.142 |
| The details in the sign-outs I provide are the right amount | 76.9% (10/13) | 71.4% (5/7) | 75% (3/4) | 1.000 |
| The sign-out I provide is always up to date | 61.5% (8/13) | 57% (4/7) | 25% (1/4) | 0.468 |