Transforming the transfer process: A quality improvement project to assess and improve transfer notes.

Transfer notes (TNs) standardize handoffs from one inpatient unit to another to optimize patient safety. They are especially important when patients are downgraded from high acuity settings such as intensive care units (ICU). Despite this, there is a paucity of evidence around safe transfers. The study objective was to assess the impact of a quality improvement initiative on the completion rate and quality of TNs. A retrospective chart review of TNs was conducted at a single academic center in Baltimore, MD. We analyzed 76 MICU to floor transfers pre-intervention and 73 transfers during the intervention period. Note quality was determined using a novel TN assessment tool; validity evidence was established. Chi-square analysis was used to compare the presence and quality of TNs. There was a statistically significant increase in note completion rate from 19.7% to 42.5 % during the study (p < 0.003). There was a statistically significant increase in mean quality of completed TNs (10.3 pre-intervention vs. 12.3 intervention period: maximum score 15, p = 0.005). This QI intervention appears to have translated into more consistent and higher quality TNs. These improvements should facilitate better and safer care of patients moving from MICU to medical floors.

What are the attitudes of medical students and housestaff towards health advocacy? A physician-led voter registration initiative and health advocacy survey.

Background: Compared to the general population, physicians have been shown to be less engaged in civic participation and less likely to vote. However, perspectives of current trainees on health advocacy remain under-explored. Objective: To investigate perspectives on a physician led voter registration initiative and identify current beliefs of physicians in training and medical students regarding physician health advocacy. Design: Cross sectional survey performed at a single urban academic center. Participants: A total of 366 medical students, residents, and fellows voluntarily participated in the survey out of a total of 1,719 available (21% response rate). Main Measures: We examined the current perceptions surrounding health advocacy among medical students and physicians in training and how this was impacted by the COVID-19 pandemic. Responses were analyzed using Chi-square analysis and logistic regression. Key Results: The voter registration code was scanned 131 times prior to the 2020 Presidential elections. Barriers to hospital-based voter registration included lack of time, lack of fit into the workflow and forgetting to ask. Over half of internal medicine-based residents and fellows (51%) and medical students (63%) agreed that physicians should be involved in helping patients register to vote compared to 34% of surgical-based trainees. A large majority (87%) indicated that the COVID-19 pandemic made it more necessary for physicians to be involved in politics. Conclusion: A high proportion of medical students and housestaff across specialties report an obligation to be involved in health advocacy, though there were differing views towards direct involvement in voter registration.