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Residency Outpatient Handovers

By William Martinez Moderator | 01 Jul, 2014

It is that time of year. In many places across the US, new interns will start tomorrow. In primary care specialties, many of these interns will inherit a panel of patients from a graduating resident and serve as their primary care physician for the duration of their residency. Some patients go through this transition every few years from one resident to the next. Residency clinics tend to serve poorer, more vulnerable populations (e.g., more patients with medicaid or safety net insurance and patient in the VA system), and because many are affiliated with academinc, tertiary care center they include some of the sickest and most complex patients. Many of these patients may have to wait weeks to meet their new doctor. They may be in midst of an evaluation for seriour illness or in crisis or have pending test results and meds that need to be refilled. This transition phase can pose a real threat to quality and safety, yet standardized procedures for these handovers are only just beginning to take hold.

What are you doing at your hospital or clinic?
What ideas do you have on how to improve these transitions?
Are you aware of any good models in this area that could be shared with others?

There are broader questions too about how to ensure that vulnerable groups are not disportionately affected by any risks associated with the medical education system. What can be done to assist our most vulnerable patients during this transition when they are most at risk of having things fall through the cracks?

Replies

 

Benjamin Grant Replied at 9:26 AM, 7 Jul 2014

This is an situation facing patients across the US. In my experience, transitions are not done overnight. The arrangement is as such that the incoming resident would arrive at his/her assigned facility at least a few weeks prior to the graduating resident transitioning out. This gives time for proper handing over of attending patients' management profile, as well as teaching.
I therefore think a process review is necessary to redesign this transition of residents in hospitals, to prevent undue complications and ensure patient well-being.

William Martinez Moderator Replied at 10:31 PM, 13 Jul 2014

Most of the improvements in this area, that I am aware of, have focused on creating a written pass-off on a templated note that prompts the out going resident to provide some form of signout to the incoming intern. Usually this is done only for the most complex patients and the others transition over without any formalized pass-off. Benjamin however raises a good point. Would it not be better to allow more overlap between the outgoing resident and incoming intern that would at least faciliate that asking of questions and clarifications? or a more gradual transition?

I will say that these transitions are not limited to resident clinics. Attending physicians also leave, retire, change practices. In some ways that process is even less formalized in my experience.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.