The Safe Discharge Checklist: A Standardized Discharge Planning Curriculum for Medicine Trainees. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Eden, Elizabeth L.; Rothenberger, Scott; DeKosky, Allison; Donovan, Anna K.
• Is Part Of: Southern medical journal. Volume 115:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: curriculum design, implementation, and evaluation -- graduate medical education -- hospital discharge -- hospital medicine -- systems-based practice; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000001341
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract: Objectives: Hospital discharge is a challenging time for residents, requiring the completion of many tasks to ensure safe transitions for patients. Despite recognition of the importance of hospital discharge planning, formal curricula are lacking. We sought to improve medicine residents' comfort and skills with discharge planning and enhance the quality of care by introducing a standardized approach to discharge on the medicine wards. Methods: The intervention included a didactic, a bedside rounds component, and a discharge checklist. Interns were surveyed at the end of rotations to measure confidence, attitudes, and frequency of completing discharge planning tasks. Results were compared with a control group of experienced interns from the previous academic year. Clinical outcomes included hospital readmission and emergency department return rates and patient satisfaction scores in discharge-related domains. Results: Study interns reported similar confidence to control group interns with discharge planning and endorsed completing four of five discharge tasks more frequently than control interns. There were no differences in clinical outcomes. Conclusions: We did not identify changes in clinical outcomes, although this finding likely reflects the multifactorial nature of hospital readmissions. Interns exposed to the curriculum early in the academic year had a higher reported frequency of completing key discharge tasks and similar confidence around discharge, when compared with end-of-the-year interns. These improvements suggest that the curriculum led to a change in culture surrounding discharge planning and perhaps accelerated learning of skills associated with discharge best practices. Abstract : Hospital discharge is a high-risk time for patients, and the skills necessary to safely discharge a patient can be challenging for resident physicians to learn. This article describes a multifaceted hospital discharge curriculum for Internal Medicine residents at one large academic training program. Interns who participated in the educational intervention had earlier and more consistent development of key discharge skills, when compared with a control group of interns at the end of their intern year. This feasible and well-received curriculum could be useful to other residency training programs looking to teach these less-codified skills.Supplemental digital content is available in the text.