Transitions from hospitals to the ambulatory setting are high risk periods for patients. The success of efforts to improve transitional care likely depends in part on local attitudes, culture, workload, and training. Prior to implementation of a multi-faceted transitions intervention, we strove to better understand these contextual factors among providers involved in care transitions across provider types, hospital units, and outpatient practices.
As part of the Partners-PCORI Transitions Study, we conducted a survey of baseline opinions of transitional care practices. We purposefully sampled providers of all types involved in care transitions, including residents, attending physicians, nurses, care coordinators, pharmacists, and social workers, and to be from every medical and surgical inpatient unit within the participating hospital and every participating primary care practice affiliated with that hospital. Survey questions included several topics, including time for, training in, and feedback on transitional tasks; and opinions on the quality of transitions of care for the patients they care for. Results are presented using descriptive statistics.
We administered surveys to 200 providers, and 119 responded (response rate 60%) from 8 different practices and 7 inpatient units. As shown in Table 1, a large proportion of respondents said they had never received training, were given insufficient time, and had never received feedback on key transitional care activities. In Table 2, respondents on average said that the transitions process leads to positive outcomes some to most of the time (mean scores 4.74 to 5.09 on a 1-7 scale). Respondents gave somewhat lower scores to the efficiency and workflow questions (mean scores 4.14 to 4.15).
At one hospital and its affiliated primary care practices participating in a multi-faceted effort to improve transitional care, respondents felt that training, feedback, and time allotted to key transitional care activities were often inadequate. Satisfaction with the quality of the transitions process and its impact on patients was middling. Understanding these results, and especially variation by role and location, will be important to optimizing implementation of the interventions underway in the Partners-PCORI Transitions Study and to understanding possible variation in the success of the intervention across locations. We recommend that similar contextual surveys be performed in other health care systems prior to implementing efforts to improve transitions of care.