Background: High quality discharges improve patients’ health outcomes and experience and are a vital component of resident education. Our internal medicine residency program has had challenges in sustaining our efforts to improve discharge planning and in providing resident feedback on the process. Furthermore, despite access to “big data”, many residency programs struggle to find meaningful and relevant feedback that reflects individual resident performance. Specific feedback on patient interactions is highly desired by residents, impacts patient experience, and fulfills important ACGME educational requirements, yet is time-intensive and often inconsistent.
Purpose: The purpose of our innovation is to improve patient experience and resident performance feedback through the lens of education around transitions of care by leveraging institutional support around observation and feedback.
Description: Our health system has provided resources aimed at improving patient experience including instructional videos, written materials, and individual observation and feedback on patient interactions. Just prior to the start of a ward rotation, residents watch short customized portions of the instructional video highlighting physician behaviors that can positively impact patient and family member understanding of illness and home care. Each week of the rotation, team members from the Patient Experience (PX) team join rounds with a different ward team in order to make several assessments of each resident over time. Throughout the week, PX team members observe and assess residents’ utilization and delivery of the specific behaviors using a standardized feedback tool we created based on the perspective of the patient. The observers provide residents with individualized verbal and written feedback based on observation and patient input. This information is then shared with the attending physician in order to monitor for sustained improvement in future patient interactions.
Conclusions: Leveraging institutional resources to enhance patient experience offers our program three successes in one by 1) facilitating resident education through meaningful real-time feedback in the vital area of transitions of care, 2) meeting patient needs for enhanced discharge education, and 3) improving institutional patient experience scores. This type of program requires strong resident engagement and collaboration between the patient experience team and the residency program. Resident physicians highly rate the value of immediate and targeted feedback in this setting. Institutional support, partnership and shared priorities allow for the necessary resources to achieve our goal of timely and efficient feedback to residents and ultimately to improved patient outcomes and experience.