scholarly journals Enhanced Scheduling Support to Improve Continuity of Care in a Resident Training Clinic

2020 ◽  
Vol 12 (2) ◽  
pp. 208-211
Author(s):  
Nancy A. LaVine ◽  
Daniel J. Coletti ◽  
Jennifer Verbsky ◽  
Lauren Block
Keyword(s):  
Internal Medicine Resident ◽  
Resident Training ◽  
Direct Communication ◽  
Patient Reports ◽  
Medicine Resident ◽  
Training Clinic ◽  
Control Clinic ◽  
Front Desk ◽  
Intervention Clinic

ABSTRACT Background Clinical continuity is recognized as a driver of satisfaction for patients and physicians. Greater continuity may positively affect trainee decisions to enter primary care. Maintaining clinical continuity remains a challenge in residency clinics. Objective We determined whether enhanced scheduling support was associated with improvement in internal medicine resident continuity with patients. Methods This study was conducted from June 2017 to December 2018. In the intervention clinic, a single scheduling staff member (ratio of 10 residents to 1 scheduler) was colocated within the clinical space, allowing the scheduler to participate in clinical discussions and direct communication with physicians regarding future appointments. In the comparison clinic, scheduling staff (19:1 ratio) were located at a remote front desk area and relied on patient reports or electronic health record orders to identify appointment needs and arrange follow-up appointments. The main outcome of the intervention was resident continuity, calculated using the continuity for physician formula. Results During the study period, mean resident continuity was 23% (range 13%–37%) in the comparison clinic (57 residents) and 54% (range 38%–66%) in the intervention clinic (10 residents). Resident continuity was significantly higher in the intervention clinic compared with the traditional control clinic for every quarter measured (P < .001 for all comparisons). Conclusions Enhancing scheduling support through colocation and a lower resident to scheduler ratios was associated with significantly higher rates of resident continuity compared with a traditional front desk model, with results sustained over 18 months.

scholarly journals “JUMPing into Diabetes Control”: A Group-Setting Self-Empowerment Lifestyle Intervention among Diabetes Patients

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 90
Author(s):  
Sheena Henry ◽  
Lu Shi ◽  
Virginia Alexander ◽  
Richard O’Neal ◽  
Stephen Carey ◽  
...  
Keyword(s):  
Group Intervention ◽  
Internal Medicine Resident ◽  
Mean Value ◽  
T Test ◽  
Post Intervention ◽  
Medicine Resident ◽  
Significant Difference ◽  
One Year ◽  
Paired T Test

We examined the impact of a group-based self-empowerment intervention among diabetes patients, which uses multidisciplinary education, collaborative learning, peer support, and development of diabetes-specific social capital to improve glycemic control and weight management. Thirty-five patients who had primary care established at the Prisma Health Upstate, Internal Medicine Resident clinic and held the diagnosis of diabetes for longer than one year were recruited for our single-arm pilot intervention. Each group intervention session involved one to two internal medicine resident physician facilitators, a clinical diabetic educator, and 5–10 patients. Each session had a framework facilitated by the resident, with most of the discussion being patient-led, aiming to provide a collaborative learning environment and create a support group atmosphere to encourage self-empowerment. Patients’ hemoglobin A1c level and body mass index (BMI) before the intervention and 3 to 6 months after completion were collected from the laboratory results obtained in the participants’ routine clinic visits. All graduates from this three-week intervention were invited to attend monthly maintenance sessions, and we tracked the HgbA1c measures of 29 JUMP graduates one year after the intervention, even though 13 of the 29 chose not to participate in the monthly maintenance sessions. The pre-intervention HgbA1c level averaged 8.84%, whereas the post-intervention HgbA1c level averaged 7.81%. A paired t test showed that this pre–post difference of 1.03 percentage points was statistically significant (p = 0.0007). For BMI, there was an average decline of 0.78 from the pre-intervention mean value of 40.56 to the post-intervention mean value of 39.78 (p = 0.03). Among the 29 participants who agreed to participate in our follow-up measure of their HgbA1c status one year after the intervention, a paired t test showed that there was no significant difference between the post-JUMP measure and the follow-up measure (p = 0.808). There was no statistically significant difference between the HgbA1c level of those participating in the maintenance program and that of those not participating (post-intervention t test of between-group difference: p = 0.271; follow-up t test of between-group difference: p = 0.457). Our single-arm, pilot study of the three-week group intervention of self-empowerment shows promising results in glycemic control and weight loss. The short duration and small number of sessions expected could make it more feasible for implementation and dissemination as compared with popular intervention protocols that require much longer periods of attendance, if the effectiveness of this patient group-based self-empowerment approach can be further established by randomized controlled studies in the future.

Internal Medicine Resident Training and Provision of Diabetes Quality of Care Indicators

2015 ◽  
Vol 39 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Bishnu P. Devkota ◽  
Michael Ansstas ◽  
Jeffrey F. Scherrer ◽  
Joanne Salas ◽  
Chakra Budhathoki
Keyword(s):  
Internal Medicine ◽  
Quality Of Care ◽  
Internal Medicine Resident ◽  
Resident Training ◽  
Medicine Resident

scholarly journals Float or sink: a solution to the resident burn-out crisis?

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Candice Luo ◽  
George Hu ◽  
Tony Chen
Keyword(s):  
New York ◽  
Patient Care ◽  
Working Hours ◽  
Internal Medicine Resident ◽  
Resident Training ◽  
Personal Lives ◽  
Medicine Resident ◽  
Burn Out ◽  
Resident Wellness ◽  
The Impact

Introduction As medical students, we were always told that medicine is a tough road. The training is gruelling with endless hours of studying, patient care, and considerable sacrifices in our personal lives. Many came into this profession ready for long hours and difficult training. However, until residency, it is tough to envision what the experience really entails.  Recently, a debate erupted in the Medical Twitter universe when Dr. Colleen Farrell, an Internal Medicine resident at Bellevue Hospital in New York, wrote a tweet decrying 27-hour resident call shifts as inhumane. Dr. Farrell argued that residents and staff physicians deserve protection against harsh working hours and conditions on par with workers in unionized professions. For instance, the Ontario Nurses Association closely regulates how long nurses can work in a given day with the minimal time nurses must receive for breaks1. The ensuing debate saw numerous residents and staff physicians joining the conversation on either side of the argument. Many physicians argued that extended call shifts are a necessary part of resident training which equips residents to work effectively and independently in future demanding roles. On the other hand, many suggest that the lack of adequate rest and humane working hours leaves residents ill-prepared to make decisions and may hinder patient care. In the end, Dr. Farrell received heavy backlash that led to her taking a break from Twitter. But what does the research say? Does reducing working hours improve resident wellness and patient safety? What is the impact on resident education? Can there be a way to balance resident wellness with competency and quality of 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 A Resident-Led Intervention to Increase Initiation of Buprenorphine Maintenance for Hospitalized Patients With Opioid Use Disorder

2021 ◽  
Vol 16 (6) ◽  
Author(s):  
Ashish P Thakrar ◽  
David Furfaro ◽  
Sara Keller ◽  
Ryan Graddy ◽  
Megan Buresh ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Methadone Maintenance ◽  
Internal Medicine Resident ◽  
Opioid Use Disorder ◽  
Hospitalized Patients ◽  
Opioid Use ◽  
Medicine Resident ◽  
Clinician Education ◽  
Engagement In Treatment

BACKGROUND: Hospitalized patients with opioid use disorder (OUD) are rarely started on buprenorphine or methadone maintenance despite evidence that these medications reduce all-cause mortality, overdoses, and hospital readmissions. OBJECTIVE: To assess whether clinician education and a team of residents and hospitalist attendings waivered to prescribe buprenorphine increased the rate of starting patients with OUD on buprenorphine maintenance. DESIGN, SETTING, PARTICIPANTS: Quality improvement study conducted at a large, urban, academic hospital in Maryland involving hospitalized patients with OUD on internal medicine resident services. INTERVENTION: We developed a protocol for initiating buprenorphine maintenance, presented an educational conference, and started the resident-led Buprenorphine Bridge Team of residents and attendings waivered to prescribe buprenorphine to bridge patients from discharge to follow-up. MEASUREMENTS: The percent of eligible inpatients with OUD initiated on buprenorphine maintenance, 24 weeks before and after the intervention; engagement in treatment after discharge; and resident knowledge and comfort with buprenorphine. RESULTS: The rate of starting buprenorphine maintenance increased from 10% (30 of 305 eligible patients) to 24% (64 of 270 eligible patients) after the intervention, with interrupted time series analysis showing a significant increase in rate (14.4%; 95% CI, 3.6%-25.3%; P = .02). Engagement in treatment after discharge was unchanged (40%-46% engaged 30 days after discharge). Of 156 internal medicine residents, 89 (57%) completed the baseline survey and 66 (42%) completed the follow-up survey. Responses demonstrated improved resident knowledge and comfort with buprenorphine. CONCLUSION: Internal medicine resident teams were more likely to start patients on buprenorphine maintenance after clinician education and implementation of a Buprenorphine Bridge Team.

Drug Alert Experience and Salience during Medical Residency at Two Healthcare Institutions

2021 ◽  
Vol 12 (02) ◽  
pp. 355-361
Author(s):  
Kinjal Gadhiya ◽  
Edgar Zamora ◽  
Salim M. Saiyed ◽  
David Friedlander ◽  
David C. Kaelber
Keyword(s):  
Internal Medicine ◽  
Residency Training ◽  
Medical Center ◽  
Internal Medicine Resident ◽  
Clinical Decision ◽  
University Of Pennsylvania ◽  
Teaching Hospitals ◽  
Medicine Resident ◽  
Internal Medicine Residents ◽  
The University

Abstract Background Drug alerts are clinical decision support tools intended to prevent medication misadministration. In teaching hospitals, residents encounter the majority of the drug alerts while learning under variable workloads and responsibilities that may have an impact on drug-alert response rates. Objectives This study was aimed to explore drug-alert experience and salience among postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) internal medicine resident physicians at two different institutions. Methods Drug-alert information was queried from the electronic health record (EHR) for 47 internal medicine residents at the University of Pennsylvania Medical Center (UPMC) Pinnacle in Pennsylvania, and 79 internal medicine residents at the MetroHealth System (MHS) in Ohio from December 2018 through February 2019. Salience was defined as the percentage of drug alerts resulting in removal or modification of the triggering order. Comparisons were made across institutions, residency training year, and alert burden. Results A total of 126 residents were exposed to 52,624 alerts over a 3-month period. UPMC Pinnacle had 15,574 alerts with 47 residents and MHS had 37,050 alerts with 79 residents. At MHS, salience was 8.6% which was lower than UPMC Pinnacle with 15%. The relatively lower salience (42% lower) at MHS corresponded to a greater number of alerts-per-resident (41% higher) compared with UPMC Pinnacle. Overall, salience was 11.6% for PGY-1, 10.5% for PGY-2, and 8.9% for PGY-3 residents. Conclusion Our results are suggestive of long-term drug-alert desensitization during progressive residency training. A higher number of alerts-per-resident correlating with a lower salience suggests alert fatigue; however, other factors should also be considered including differences in workload and culture.

scholarly journals Military Internal Medicine Resident Decision to Apply to Fellowship and Extend Military Commitment

2018 ◽  
Vol 183 (7-8) ◽  
pp. e299-e303 ◽  
Author(s):  
Alice E Barsoumian ◽  
Joshua D Hartzell ◽  
Erin M Bonura ◽  
Roseanne A Ressner ◽  
Timothy J Whitman ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Internal Medicine Resident ◽  
Medicine Resident

LETTER TO EDITOR – ORPHAN IMPLANTS

2021 ◽  
Author(s):  
Santhosh Shenoy ◽  
Raghavendra Vamsi Anegundi
Keyword(s):  
Patient Reports ◽  
Lost To Follow Up

Orphan Implants are encountered when the dentist places an implant, and for some reason, the patient is lost to follow up, and he visits a second dentist for the restoration. The latter will have no clue regarding the implant in the patient's mouth in such a situation. This situation is also expected when the clinician uses multiple implant brands, and the patient reports after some years for a restoration, which leaves the clinician clueless if the clinician does not maintain proper implant records.

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