Background: Since the pilot project for the “hospitalist system” began in South Korea in September 2016, hospitalists have been delivering specialized care to inpatients, serving as experts in the field of hospitalization. Given the various reasons such as duty rotations, surgical procedures, and transfers, it is essential for hospitalized patients to undergo changes in their primary physicians. The transitions of care play a crucial role in managing inpatients, and any incorrect transition poses a direct threat to patient safety. However, there is a growing concern within the hospitalist system regarding the frequent care transitions that are inevitable. Therefore, our objective is to assess both the frequency and quality of care transitions in the early stages of the system’s implementation.
Methods: This study investigated the frequency and quality of care transitions in inpatients discharged between June 12 and 18, 2022, from four hospitalist-service hospitals in South Korea. The analysis included all internal medicine and general surgery inpatients aged 19 years or older with a hospital stay of 1 day or more. Care transitions were categorized according to their specific characteristics as shift changes, service changes, and service transfers. A shift change means temporarily switching a patient to a new physician at the end of a shift, such as on-call. A change of service means a permanent change in the primary physician treating the patient due to a change in different department. A service transfer refers to a change in primary physicians within the same department for reasons such as vacation, intensive care unit transfer, or rotation. We reviewed written medical reports for quality assessment. Shift changes were assessed by the number of handoffs written. In the case of service change and service transfer Q1) whether treatment progress after visit to the hospital was written, and Q2) whether future plans were written were evaluated.
Results: We analyzed total 735 patients from 4 hospitals. The mean age was 63.7 ± 15.9 years and 399 (54.3 %) was male. Average length of stay in hospital is 8.1 days. Shift changes occurred a total of 5189 times, with an average of 7.1 ± 9.5 times per patient. A total of 520 service transfers and 69 service changes occurred. Of these, the number of legitimate handovers through shift replacement was 255 (4.6%). Shift transfer was written appropriately 341 times (65.6%) for Q1 and 356 times (68.5%) for Q2. In service transfer, it was written 43 times (62.3%) for Q1 and 42 times (60.9%) for Q2 was written appropriately. There was no difference in the quality and quantity of care transitions between internal and surgical patients. Additionally, no differences were observed in the number of service transfers and shift transfers between hospitalists and specialists. There is no difference in the number of shift changes, and there is no significant difference in qualitative evaluation of all care transitions.
Conclusions: For the first time in South Korea, we analyzed the frequency of care transition and checked a qualitative evaluation. During the qualitative assessment, it became evident that there is a notable lack of information in the written care transition process. This finding underscores the need for additional research efforts aimed at improving the care transition procedures in South Korea.