X.E. Transitions of Care

Programs must design clinical assignments to optimize transitions in patient care including their safety, frequency, and structure. Programs in partnership with the School of Medicine and participating institution must ensure and monitor effective, structured hand-over processes to facilitate both continuity of care and patient safety. Programs must ensure that House Officers are competent in communicating with team members in the hand-over process. Programs and clinical sites must maintain and communicate schedules of attending physicians and House Officers currently responsible for care. Programs will ensure continuity of patient care, if House Officer may be unable to perform their patient care responsibilities due to excessive fatigue or illness.
This transitions policy is created with recognition that multiple studies have shown that transitions of care create the most risk or medical errors. ACGME teleconference July 14, 2010 In addition to the below specific policies, promotion of patient safety is further ensured by:

• Provision of complete and accurate rotational schedules in New Innovations
• Presence of a backup call schedule for those cases where a House Officer is unable to complete their duties.
• The ability of any House Officers to be able to freely and without fear of retribution report their inability to carry out their clinical responsibilities due to fatigue or other causes.

House Officers receive educational material on Transitions at Orientation and as a core module.
In any instance where care of a patient is transferred to another member of the health care team an adequate transition must be used. Although transitions may require additional reporting than in this policy a minimum standard for transitions must include the following information:

• Demographics: Name, medical record number, unit/room number, age, weight, gender, allergies attending physician phone numbers
• History and Problem List: Primary diagnosis(es), chronic problems (pertinent to this admission/shift)
• Current condition status
• System based list: Pertinent medications and treatments, oral and IV medications, IV fluids, blood products, oxygen, respiratory therapy interventions.
• Pertinent lab data
• To do list: Check x-ray, labs, wean treatments, etc. - rationale
• Contingency planning: what may go wrong and what to do
• Anticipate what will happen to your patient: If this …than that….
• Code status/family situation
• Difficult family or psychosocial situations

Programs will periodically sample transitions including a sample of a patients chart and interview of incoming team to ensure that key elements are transmitted and have been understood.
Faculty are required to answer a question on effectiveness of witnessed transitions on evaluations. Periodic sampling will occur by the Graduate Medical Education Office.