scholarly journals Use of a 90-Minute Admission Window and Front-Fill System to Reduce Work Compression on a General Medicine Inpatient Teaching Service

2017 ◽  
Vol 9 (2) ◽  
pp. 245-249 ◽  
Author(s):  
Youngjee Choi ◽  
Daniel Kim ◽  
Hyemi Chong ◽  
Christopher Mallow ◽  
Jason Bill ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Care ◽  
General Medicine ◽  
General Ward ◽  
Timely Manner ◽  
Training Experience ◽  
Resident Perceptions ◽  
Before And After ◽  
Time To Learn ◽  
Resident Learning

ABSTRACT Background Duty hour limits have shortened intern shifts without concurrent reductions in workload, creating work compression. Multiple admissions during shortened shifts can result in poor training experience and patient care. Objective To relieve work compression, improve resident satisfaction, and improve duty hour compliance in an academic internal medicine program. Methods In 2014, interns on general ward services were allotted 90 minutes per admission from 3 pm to 7 pm, when the rate of admissions was high. Additional admissions arriving during the protected period were directed to hospitalists. Resident teams received 2 patients admitted by the night float team to start the call day (front-fill). Results Of the 51 residents surveyed before and after the implementation of the intervention, 39 (77%) completed both surveys. Respondents reporting an unmanageable workload fell from 14 to 1 (P < .001), and the number of residents reporting that they felt unable to admit patients in a timely manner decreased from 14 to 2 (P < .001). Reports of adequate time with patients increased from 16 to 36 (P < .001), and residents indicating that they had time to learn from patients increased from 19 to 35 (P < .001). Reports of leaving on time after call days rose from 12 to 33 (P < .01), and overall satisfaction increased from 26 to 35 (P = .002). Results were similar when residents were resurveyed 6 months after the intervention. Conclusions Call day modifications improved resident perceptions of their workload and time for resident learning and patient care.

scholarly journals Using a Resident Discharge Clinic for Resident Education and Patient Care: A Feasibility Study

2014 ◽  
Vol 6 (3) ◽  
pp. 536-540 ◽  
Author(s):  
Katrina A. Booth ◽  
Lisa M. Vinci ◽  
Julie L. Oyler ◽  
Amber T. Pincavage
Keyword(s):  
Internal Medicine ◽  
Care Transitions ◽  
Internal Medicine Resident ◽  
Readmission Rates ◽  
Resident Perceptions ◽  
Medicine Resident ◽  
Baseline Group ◽  
Before And After ◽  
Resident Learning

Abstract Background Many patients in internal medicine resident continuity clinics experience difficulty accessing care, making posthospitalization ambulatory follow-up challenging. Experiential learning in care transitions is also lacking for residents. Objective We sought to assess the feasibility and impact of a weekly Resident Discharge Clinic (RDC) in increasing access to early posthospitalization follow-up and providing learning opportunities for residents. Methods We staffed the RDC with an ambulatory block resident, an internal medicine preceptor, and a clinical pharmacist. We assessed time to posthospitalization follow-up, readmission rates, and resident perceptions of postdischarge care for resident-clinic patients, comparing data before and after RDC implementation. Results There were 636 discharges in the baseline group, 662 during the intervention period, and 56 in the RDC group. Six months after RDC implementation, the percentage of discharged resident-clinic patients with follow-up within 7 days improved from 6.6% at baseline to 9.7% (P  =  .04). The mean interval to the posthospitalization follow-up appointment in the RDC group was 7.4 days compared with 33.9 days in the baseline group (P < .001). The percentage of surveyed residents (n  =  72) who agreed that early follow-up was easy to arrange increased from 21% to 77% (P < .001). There was no significant decrease in the 30-day readmission rate for patients in the RDC group (18.1% versus 12.5%, P  =  .29). Conclusions The RDC was easily implemented, increased access to timely posthospitalization follow-up, and provided a platform for resident learning about care transitions.

scholarly journals Utilizing Electronic Medical Records to Standardize Handoffs in Academic Ophthalmology

2020 ◽  
Vol 12 (02) ◽  
pp. e205-e213
Author(s):  
Lynn W. Sun ◽  
Andrea L. Stahulak ◽  
Deborah M. Costakos
Keyword(s):  
Patient Care ◽  
Ease Of Use ◽  
Resident Perceptions ◽  
Medical Centers ◽  
Resident Physicians ◽  
Major Metropolitan Area ◽  
Academic Medical ◽  
Before And After ◽  
Measured Efficiency ◽  
Inpatient Settings

Abstract Purpose Formalized handoff procedures have been shown to increase patient safety and quality of care across multiple medical and surgical specialties,1–4 but literature regarding handoffs in ophthalmology remains sparse. We instituted a standardized handoff utilizing an electronic medical record (EMR) system to improve care for patients shared by multiple resident physicians across weekday, weeknight, and weekend duty shifts. We measured efficiency, efficacy, and resident satisfaction before and after the standardized handoff was implemented. Methods Resident physicians surveyed were primarily responsible for patient care on consult and call services at two quaternary academic medical centers in a major metropolitan area. Patient care was performed in outpatient, emergency, and inpatient settings. Annual anonymous questionnaires consisting of 6 questions were used to collect pre- and postintervention impressions of the standardized EMR handoff process from ophthalmology resident physicians (9 per year; 3 preintervention years and 1 postintervention year). An additional anonymous postintervention questionnaire consisting of 12 questions was used to further characterize resident response to the newly implemented handoff procedure. Results Prior to implementation of a standardized EMR-based handoff procedure, residents unanimously reported incomplete, infrequently updated handoff reports that did not include important clinical and/or psychosocial information. Following implementation, residents reported a statistically significant increase in completeness and timeliness of handoff reports. Additionally, resident perception of EMR handoff utility, efficiency, and usability were comprehensively favorable. Residents reported handoffs only added a mean of 6.5 minutes to a typical duty shift. Conclusion Implementation of our protocol dramatically improved resident perceptions of the handoff process at our institution. Improvements included increased quality, ease-of-use, and efficiency. Our standardized EMR-based handoff procedure may be of use to other ambulatory-based services.

scholarly journals Rounds Today: A Qualitative Study of Internal Medicine and Pediatrics Resident Perceptions

2016 ◽  
Vol 8 (4) ◽  
pp. 523-531 ◽  
Author(s):  
Raphael Rabinowitz ◽  
Jeanne Farnan ◽  
Oliver Hulland ◽  
Lisa Kearns ◽  
Michele Long ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Qualitative Study ◽  
Patient Care ◽  
Family Involvement ◽  
Clinical Education ◽  
Comparative Method ◽  
Teaching Hospitals ◽  
Resident Perceptions ◽  
Attending Rounds ◽  
Teaching Learning

ABSTRACT Background  Attending rounds is a key component of patient care and education at teaching hospitals, yet there is an absence of studies addressing trainees' perceptions of rounds. Objective  To determine perceptions of pediatrics and internal medicine residents about the current and ideal purposes of inpatient rounds on hospitalist services. Methods  In this multi-institutional qualitative study, the authors conducted focus groups with a purposive sample of internal medicine and pediatrics residents at 4 teaching hospitals. The constant comparative method was used to identify themes and codes. Results  The study identified 4 themes: patient care, clinical education, patient/family involvement, and evaluation. Patient care included references to activities on rounds that forwarded care of the patient. Clinical education pertained to teaching/learning on rounds. Patient/family involvement encompassed comments about incorporating patients and families on rounds. Evaluation described residents demonstrating skill for attendings. Conclusions  Resident perceptions of the purposes of rounds aligned with rounding activities described by prior observational studies of rounds. The influence of time pressures and the divergent needs of participants on today's rounds placed these identified purposes in tension, and led to resident dissatisfaction in the achievement of all of them. Suboptimal congruency exists between perceived resident clinical education and specialty-specific milestones. These findings suggest a need for education of multiple stakeholders by (1) enhancing faculty teaching strategies to maximize clinical education while minimizing inefficiencies; (2) informing residents about the value of patient interactions and family-centered rounds; and (3) educating program directors in proper alignment of inpatient rotational objectives to the milestones.

Adjunctive Phenobarbital for Alcohol Withdrawal Syndrome: A Focused Literature Review

2021 ◽  
pp. 106002802199982
Author(s):  
Julie A. Murphy ◽  
Brittany M. Curran ◽  
William A. Gibbons ◽  
Holly M. Harnica
Keyword(s):  
Patient Care ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Data Extraction ◽  
General Medicine ◽  
Alcohol Withdrawal Syndrome ◽  
Data Synthesis ◽  
Study Selection ◽  
Before And After

Objective: To review the literature describing the use of adjunctive phenobarbital in the treatment of severe alcohol withdrawal syndrome (AWS). Data Sources: PubMed and EMBASE were searched using the following terms: phenobarbital, adjunct, refractory or treatment resistant, severe or complicated, and alcohol withdrawal delirium or alcohol withdrawal seizures. Study Selection and Data Extraction: The search was limited to randomized controlled trials (RCTs) and cohort studies published in English. Data Synthesis: Seven studies were identified in the emergency department (ED; RCT, n = 1; cohort, n = 2), general medicine ward (cohort, n = 1), and intensive care unit (ICU; cohort, n = 3) settings. For all studies set in the ED and general medicine ward and for 1 ICU study, phenobarbital plus symptom-guided benzodiazepine therapy was compared to symptom-guided benzodiazepine monotherapy. The other 2 ICU studies examined adjunctive phenobarbital before and after implementation of a protocol, meaning patients in both arms could have received phenobarbital. Overall risk of bias across all studies was low to moderate. Relevance to Patient Care and Clinical Practice: The specific role of adjunctive phenobarbital in AWS is not clear because a majority of studies are retrospective cohorts with varying primary outcomes in different patient care settings. Conclusions: In the ED and general medicine ward, phenobarbital demonstrated benzodiazepine-sparing effects. In the ICU, when a protocol guides phenobarbital use, the need for mechanical ventilation may be reduced. Adjunctive phenobarbital was well tolerated. Because of study limitations, it is challenging to provide specific recommendations for adjunctive phenobarbital use in severe AWS.

Effect of a Computer-Assisted General Medicine Diagnostic Consultation Service on Housestaff Diagnostic Strategy

1989 ◽  
Vol 28 (04) ◽  
pp. 352-356 ◽  
Author(s):  
R. Bankowitz ◽  
M. McNeil ◽  
S. Challinor ◽  
R. Miller
Keyword(s):  
Internal Medicine ◽  
General Medicine ◽  
Patient Specific ◽  
Computer Assisted ◽  
Diagnostic Strategy ◽  
Consultation Service ◽  
Internal Medicine Training ◽  
Before And After ◽  
Lab Test ◽  
The Impact

Abstract:Quick Medical Reference (QMR) is a microcomputer-based decision sup´port system designed to provide diagnostic assistance in the field of internal medicine. In addition to providing plausible diagnostic hypotheses based upon patient specific findings, the program highlights history, physical and laboratory items which are potentially useful in discriminating among the diagnoses under consideration. We have evaluated the impact of a computer-assisted diagnostic consultation service on the diagnostic and management strategy of a housestaff in a university internal medicine training program. Differential diagnoses were obtained before and after the use of the program, and a questionnaire was used to asses the educational value of the service and the effect of the service on the diagnosis and planned management. Over an eight week period, 31 cases were identified which met inclusion criteria. The QMR consultation added a diagnosis to the original list in 14 out of 31 cases. The consultation reordered the diagnosis in an additional 7 cases, and in 8 cases a diagnosis was ruled out by the use ofthe program. After the use of the program the housestaff reported they would obtain an additional lab test in 10 cases, change the order of planned tests. in two cases and eliminate a lab test in one case. The use of the program V)las rated as helpful educationally in 81 % of the cases, and helpful with respect to management in also 81 % of the cases.

59. General medicine residents' perception of the mini-CEXs

2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
S. Malhotra ◽  
R. Hatala ◽  
C.-A. Courneya
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Focus Group ◽  
Qualitative Study ◽  
Focus Groups ◽  
General Medicine ◽  
Clinical History ◽  
Phenomenological Approach ◽  
Medical Teacher ◽  
The Impact

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8. De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52. DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.

Internal Medicine in World War II. Volume 3. Infectious Diseases and General Medicine.

1968 ◽  
Author(s):  
Leonard D. Heaton ◽  
Robert S. Anderson ◽  
W. P. Havens ◽  
Jr
Keyword(s):  
Internal Medicine ◽  
World War Ii ◽  
Infectious Diseases ◽  
General Medicine ◽  
World War
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