Transitions curriculum impact on students and care.

BACKGROUND: Transitions of patient care from the inpatient to outpatient setting is a high-risk time often resulting in medical errors and adverse events. Transitions of care programmes have been demonstrated to reduce negative outcomes. Several professional societies have highlighted care transitions as a central pillar of patient care and therefore a crucial aspect of health professional education; however, little data exist on medical student education in this area. APPROACH: The Transitions of Care Curriculum was developed and delivered to all Harvard Medical School Core I Internal Medicine Clerkship students at Beth Israel Deaconess Medical Center, Boston, MA between January 2017 and March 2019, where 12-14 students participated each quarter and included didactic teaching followed by experiential learning. Student data were collected via postclerkship survey. Patient data were collected via chart review. Student self-reported comfort level with transitions in care skills and medical errors were analysed. EVALUATION: All student measures related to comfort with transitions in care skills demonstrated statistically significant improvement after curriculum participation(p < 0.001). Of the patients with a completed postdischarge note, students identified ≥1 postdischarge related issue in 33 of 70 patients, with multiple issues identified in many of these patients. Seventy-six total issues were identified. IMPLICATIONS: The Transitions of Care Curriculum demonstrated promising student and patient outcomes, suggesting that students can successfully learn and advance clinical skills while having a positive impact on a highly needed and important aspect of patient care by reducing postdischarge errors and adverse events.

Communication Skills Training for Internal Medicine Residents Using a Brief Animated Video.

Patient communication courses are time-intensive, making incorporation into residency curricula challenging. Using a short video could be an efficient means to teach residents communication skills. We created a 4-min animated video focused on the "ask more and summarize technique". Residents rotating on the inpatient oncology and palliative care service received a video link with a survey (S1) on the tool and its projected utility. A second survey (S2) was sent upon rotation completion to assess the utility of the technique. A 6-month follow up e-mail was sent to determine retention of skills. A total of 52/106 residents responded to S1 and 32/52 to S2. Median age was 28 years and 86% were PGY-1. On S1, 95% enjoyed the format, and 95% thought the narration was an effective learning tool and 90% that the animation was effective. A majority (87%) felt the tool would be useful. On comparing self-reported acquisition of skills for paired survey responses, there was a significant increase in asking more regarding patient questions (p = 0.04) but not summarizing back responses (p = 0.1). This tool was reported to be useful in a variety of settings including explaining prognoses, unrealistic patient expectations, upset patients, and patients with fear or anxiety. A 6-month follow up survey (n = 22) showed that almost all the respondents continued to report using the skills learned. A short video is a brief and effective tool that can be incorporated into a busy clinical curriculum to teach residents communication skills in the areas of cancer and palliative care.

Risk of in-hospital falls among medications commonly used for insomnia in hospitalized patients.

STUDY OBJECTIVES: To investigate the risk of in-hospital falls among patients receiving medications commonly used for insomnia in the hospital setting. METHODS: Retrospective cohort study of all adult hospitalizations to a large academic medical center from January, 2007 to July, 2013. We excluded patients admitted for a primary psychiatric disorder. Medication exposures of interest, defined by pharmacy charges, included benzodiazepines, non-benzodiazepine benzodiazepine receptor agonists, trazodone, atypical antipsychotics, and diphenhydramine. In-hospital falls were ascertained from an online patient safety reporting system. RESULTS: Among the 225,498 hospitalizations (median age = 57 years; 57.9% female) in our cohort, 84,911 (37.7%) had exposure to at least one of the five medication classes of interest; benzodiazepines were the most commonly used (23.5%), followed by diphenhydramine (8.3%), trazodone (6.6%), benzodiazepine receptor agonists (6.4%), and atypical antipsychotics (6.3%). A fall occurred in 2,427 hospitalizations (1.1%). The rate of falls per 1,000 hospital days was greater among hospitalizations with exposure to each of the medications of interest, compared to unexposed: 3.6 versus 1.7 for benzodiazepines (adjusted hazard ratio [aHR] 1.8, 95%CI 1.6-1.9); 5.4 versus 1.8 for atypical antipsychotics (aHR 1.6, 95%CI 1.4-1.8); 3.0 versus 2.0 for benzodiazepine receptor agonists (aHR 1.5, 95%CI 1.3-1.8); 3.3 versus 2.0 for trazodone (aHR 1.2, 95%CI 1.1-1.5); and 2.5 versus 2.0 for diphenhydramine (aHR 1.2, 95%CI 1.03-1.5). CONCLUSIONS: In this large cohort of hospitalizations at an academic medical center, we found an association between each of the sedating medications examined and in-hospital falls. Benzodiazepines, benzodiazepine receptor agonists, and atypical antipsychotics had the strongest associations.