Background: At academic centers the work of discharge planning has historically fallen on housestaff. The medical education community’s efforts to improve the trainee experience have led to an iterative process of duty hour reform and re-design. One effect has been “work compression” – each day a trainee is required to complete more tasks in less time. We developed the Discharge Liaison (DL) program for the internal medicine (IM) teaching service to redirect housestaff clerical work to an administrative assistant. We hypothesize that this program will reduce work compression, improve trainee well-being, and enhance the perceived education-service balance for housestaff.
Purpose: The primary aim is to reduce service-oriented tasks to decrease perceived work compression and improve the resident educational experience and wellness. Our secondary aim is to improve transitions of care by ensuring that follow-up appointments are made in a timely, patient-centered manner and discharge summaries are sent to primary care doctors.
Description: The project is funded by an institutional grant and is exempt from the IRB. We performed pre-surveys of IM trainees, with a response rate of 40% (57/142). 60% of residents do not regularly communicate with providers outside our hospital system, and 87% report that they spend a significant amount of time scheduling discharge appointments. 90% of trainees report that scheduling discharge appointments impacts their ability to focus on clinical care and education. 92% of residents report that scheduling discharge appointments contributes to their sense of frustration at work.
The DL is an administrative assistant with prior experience working in the medical field whose main responsibility is to schedule appointments, fax discharge summaries and request medical records at the request of IM trainees. Communication occurs in person and using Cureatr™ (secure smartphone/desktop messaging system). During the first 30 days, the DL scheduled 160 appointments. We project that the DL would schedule approximately 2000 appointments in a calendar year. We expect that the number of appointments scheduled per month will increase as the program is further socialized among housestaff.
Conclusions: We were able to seamlessly introduce the DL to the IM teaching service workflow. In-person interviews with trainees show an extremely positive response to the program, with several residents reporting that decreasing administrative burden enables them to spend more time with patients and on education. The DL quickly became an expert in making appointments to avoid common housestaff mistakes, whereas interns and residents constantly rotate to different institutions. Our post-intervention trainee surveys will assess for meaningful changes in pre-survey metrics and allow greater insight into the DL experience to ensure sustainability in the role. We will also gather outcomes data such as length of stay, readmission, show rate to follow-up appointments and patient surveys to determine whether the utilization of the DL improved patient-level outcomes and to justify permanent funding of this position.