Problem:

Suboptimal care transitions can lead to re-hospitalizations.

Intervention:

We developed a 2-week “Transitions of Care Curriculum” to train first-year internal medicine residents to improve their knowledge and skills to deliver optimal transitional care. Our objective was to use reflective writing essays to evaluate the impact of the curriculum on the residents.

Methods:

The rotation included: Transition of Care Teaching modules, Transition Audit, Transitional Care Site Visits, and Transition of Care Conference. Residents performed the above elements of care transitions during the curriculum and wrote reflective essays about their experiences. These essays were analyzed to assess for the overall impact of the curriculum on the residents.

Qualitative analysis of reflective essays was used to evaluate the impact of the curriculum. Of the 20 residents who completed the rotation, 18 reflective essays were available for qualitative analysis.

Results:

Five major themes identified in the reflective essays for improvement were: discharge planning, patient-centered care, continuity of care, goals of care discussions, and patient safety. The most discussed theme was continuity of care, with following subthemes: fragmentation of the healthcare system, disjointed care to the patients, patient specific factors contributing to lack of continuity of care, lack of primary care provider role as a coordinator of care, and challenges during discharge process. Residents also identified system-based gaps and suggested solutions to overcome these gaps.

Conclusions:

This experiential learning and use of reflective writing enhanced the residents’ self-identified awareness of gaps in care transitions and prompted them to generate ideas for systems improvement and personal actions to improve their practice during care transitions.

中文翻译：

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内科住院医师对护理过渡的看法：教育干预的结果

问题：

不理想的护理过渡可能导致再次住院。

干涉：

我们制定了为期 2 周的“护理过渡课程”来培训一年级内科住院医师，以提高他们的知识和技能，以提供最佳的过渡护理。我们的目标是使用反思性写作文章来评估课程对居民的影响。

方法：

轮换包括：护理教学模块的过渡、过渡审核、过渡期护理现场访问和护理过渡会议。居民在课程期间执行了上述护理过渡要素，并撰写了关于他们经历的反思性文章。对这些论文进行了分析，以评估课程对居民的整体影响。

反思性论文的定性分析被用来评估课程的影响。在完成轮换的 20 名居民中，有 18 篇反思性文章可用于定性分析。

结果：

反思性文章中确定的五个主要改进主题是：出院计划、以患者为中心的护理、护理的连续性、护理讨论的目标和患者安全。讨论最多的主题是护理的连续性，包括以下子主题：医疗保健系统的碎片化、对患者的护理脱节、导致护理连续性缺乏的患者特定因素、初级保健提供者缺乏护理协调者的角色以及挑战在放电过程中。居民们还发现了基于系统的差距，并提出了克服这些差距的解决方案。

结论：

这种体验式学习和反思性写作的使用增强了居民对护理过渡中差距的自我识别意识，并促使他们产生系统改进和个人行动的想法，以改善他们在护理过渡期间的实践。