Planning ahead: preparing for discharges
Abstract
Background: Systems-based practice is one of the core competencies that has been identified by the Accreditation Council for Graduate Medical Education (ACGME) as a foundational skill for resident physicians to learn so that they can “work in interprofessional teams to enhance patient safety and improve patient care quality.” In real-world practice, effective discharge planning is an important element of systems-based practice because delayed discharges are costly to health systems and harmful to patients. To prepare future resident physicians for this core competency, we developed an interactive workshop about discharge planning for graduating medical students during the Residency Transition Course.
Methods and Results: The interactive workshop consisted of a 30-minute didactic component that reviewed the importance of effective discharge planning. The didactics also introduced a systematic approach to discharge planning based on a modified version of the “4M’s” framework from the Institute for Healthcare Improvement. After the didactic component, participants engaged in interactive small group sessions during which they applied the “4M’s” framework to three case vignettes. A post-intervention survey was administered to evaluate participants’ growth in the domain of discharge planning.
Thirty-one participants attended our pilot workshop in March 2023. About 96% of participants felt that they gained knowledge about the general discharge process because of the workshop. Similarly, 93% and 90% of participants felt that they gained knowledge about home health services and the differences between discharging patients to home versus a skilled nursing facility, respectively. 96% of participants gained knowledge about who to consult for discharge planning purposes, and 96% of participants felt more confident after the workshop about facilitating safe, effective, and efficient discharges in the future.
Conclusions: Our pilot workshop was effective at increasing graduating medical students’ comfort with and confidence about effective discharge planning. Future iterations of this workshop might consider expanding the scope of the workshop to include more advanced cases and more participants. We might also consider evaluating discharge outcomes to assess the effect of the workshop on real-world patient care.