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?