Standardized Patients to Improve Work Rounds and Discharge Encounters

Background:

Discussions with patients during work rounds and at the time of hospital discharge are encounters that require substantial skill. High‐quality execution of these interactions can improve satisfaction and quality of care. Standardized patients (SPs) provide an opportunity to identify skills gaps and to train house staff on high‐quality work rounds and discharge interactions.

Methods:

Two SP encounters were created. The first encounter, “work rounds,” involved a patient with a partial small bowel obstruction (SBO) awaiting imaging. The second encounter, “discharge,” involved a patient discharge after a congestive heart failure exacerbation. As a teaching tool, a 10‐minute ideal discussion video was created for each case. Each house staff completed pre‐ and postencounter surveys investigating behavior change resulting from the encounter. Half the participants experienced the SP encounters without the teaching video (group A), whereas the other half reviewed the teaching video at the completion of the SP encounter (group B). Change in self‐reported confidence was assessed using the chi‐square test for proportions with 95% confidence interval. Demographics of the house staff were provided by the Graduate Medical Education office, and prior exposure to SPs was assessed on the day of participation.

Results:

Two hundred and twenty‐six members of the house staff from 22 programs have completed the encounters to date (Table 1). Examining change in behavior, a number of findings emerge (Table 2). For the “work rounds” case, house staff generally showed improved ratings of self‐efficacy, but these changes only reached statistical significance for group B participants when asked about their ability to conduct high‐quality work rounds for an SBO patient (P = 0.012). For the “discharge” case, group A reported improvement on only 1 question, ability to impact a heart failure patient's risk of rehospitalization (P = 0.049). Members of group B, however, reported broad improvement in their ability to conduct a high‐quality discharge discussion for heart failure (P = 0.005) and in general (P = 0.034) and in their ability to decrease rehospitalization for heart failure (P < 0.0001) and in general (P = 0.002). These results remained even when baseline demographic differences were controlled for.

TABLE 1 Demographics for Group A and B

TABLE 2 Pre and Post Survey Results (Percent answering Agree of Strongly Agree)*

Conclusions:

SP encounters can lead to improved self‐confidence for house staff in work rounds and discharge discussions. Greater improvement comes from a combination of an SP encounter and a postencounter teaching video. A teaching video combined with a standardized patient experience may be a novel way to improve quality of care.

Disclosures:

D. Chang ‐ none; M. Mann ‐ none; E. Friedman ‐ none; T. Sommer ‐ none; R. Faller ‐ none; K. Smith ‐ none