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.
Moreover, patient hand-offs are an important communication skill that transcends any individual training program. With their increasing reliance on electronic communication, CLEs would benefit from greater diligence in assuring that residents and fellows develop the verbal communication skills that assure good hand-offs. Resident and fellow hand-offs should be supervised and evaluated by faculty members in a fashion similar to evaluation of other clinical care and communication competencies. By calling attention to the importance of good hand-offs, such supervision could promote better care transitions throughout the CLE.