As front-line care providers, residents and fellows often see firsthand the consequences of ineffective and inefficient care transitions.
CLEs would benefit from including residents and fellows in strategic planning around transitions of care. When the resident and fellow role in such strategies is limited to implementing changes designed by others, they lose the opportunity to gain experience in developing systems-based approaches to quality improvement.
In many CLEs, faculty members and program directors confuse standardizing hand-offs with a request to create a single and uniform “one size fits all” solution. CLEs and the GME community should be encouraged to find solutions that standardize essential properties of the hand-off process while allowing for additional specialty- or unit-specific components as needed.
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The ACGME defines each CLER focus area in CLER Pathways to Excellence: Expectations for an Optimal Clinical Learning Environment (Executive Summary). Journal of Graduate Medical Education: September 2014, Vol. 6, No. 3, pp. 610-611.
CT Pathway 1: Education on care transitions
CT Pathway 2: Resident/fellow engagement in change of duty hand-offs
CT Pathway 3: Resident/fellow and faculty member engagement in patient transfers between services and locations
CT Pathway 4: Faculty member engagement in assessing resident-related patient transitions of care
CT Pathway 5: Resident/fellow and faculty member engagement in communication between primary and consulting teams
CT Pathway 6: Clinical site monitoring of care transitions