Falls Prevention for Older Adults.

This article summarizes a 2022 clinical practice guideline on falls prevention and management in older adults from the World Falls Guidelines Initiative.

Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs.

BACKGROUND: While there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern. OBJECTIVES: The 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country. DESIGN: Nationwide survey. PARTICIPANTS: All internal medicine program directors registered with APDIM. MAIN MEASURES: Descriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs. KEY RESULTS: Of the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year-End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff. CONCLUSIONS: Most internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.

Postdischarge Communication Between Home Health Nurses and Physicians: Measurement, Quality, and Outcomes.

OBJECTIVES: To use natural language processing (NLP) of text from electronic medical records (EMRs) to identify failed communication attempts between home health nurses and physicians, to identify predictors of communication failure, and to assess the association between communication failure and hospital readmission. DESIGN: Retrospective cohort study. SETTING: Visiting Nurse Service of New York (VNSNY), the nation's largest freestanding home health agency. PARTICIPANTS: Medicare beneficiaries with congestive heart failure who received home health care from VNSNY after hospital discharge in 2008-09 (N = 5,698). MEASUREMENTS: Patient-level measures of communication failure and risk-adjusted 30-day all-cause readmission. RESULTS: Identification of failed communication attempts using NLP had high external validity (kappa = 0.850, P < .001). A mean of 8% of communication attempts failed per episode of home care; failure rates were higher for black patients and lower for patients from higher median income ZIP codes. The association between communication failure and readmission was not significant with adjustment for patient, nurse, physician, and hospital factors. CONCLUSION: NLP of EMRs can be used to identify failed communication attempts between home health nurses and physicians, but other variables mostly explained the association between communication failure and readmission. Communication failures may contribute to readmissions in more-serious clinical situations, an association that this study may have been underpowered to detect.

Assessing Effectiveness of a Geriatrics Rotation for Second-Year Internal Medicine Residents.

BACKGROUND: Residents need to acquire an understanding of the biopsychosocial aspects of caring for older adults with chronic illness, along with effective use of interdisciplinary services inside and outside of the hospital. OBJECTIVE: We expanded the geriatric medicine experience for second-year internal medicine residents and present the results of the first year's experience. METHODS: We paired a mandatory rotation for postgraduate year-2 internal medicine residents (2 weeks of day and 1 week of night inpatient experience in the Acute Care for Elders Unit), and a 1-week outpatient systems-based practice experience with online modules and readings. Evaluation included a case presentation, an oral examination, a written questionnaire for all residents, and a global assessment of the residents' performance on the geriatrics portion of the 2012 In-Training Examination (ITE). RESULTS: All residents passed their oral examination; there was little difference between classes in systems-based practice knowledge. More than 90% (21 of 23) of the residents who took the rotation reported that it left a lasting impression on how they would care for their patients. Mean ITE scores in geriatrics for all residents increased from 53% (versus 61% overall) in 2010 to 87% (versus 81%) in 2012, although they dropped to 69% (versus 82%) in 2013. CONCLUSIONS: A rotation in geriatrics that is highly rated and covers both acute care and systems-based practice concepts is feasible for internal medicine residents. Residents did not learn detailed knowledge about specific programs for older adults, but clinical geriatrics knowledge improved.

Fast forward rounds: an effective method for teaching medical students to transition patients safely across care settings.

Adverse events commonly occur during hospital-to-home transitions and cause substantial morbidity. This study evaluated the effectiveness of Fast Forward Rounds (FFR), a novel educational intervention that aims to foster awareness of the essential elements of transitional care in 3rd-year medical students. FFR consists of two 90-minute sessions using lectures, an interactive video, small-group discussion, and a team-based learning exercise. It emphasizes functional assessment to identify patients at risk for poor discharge outcomes, promotes interdisciplinary collaboration to link vulnerable patients with appropriate services, reviews Medicare and Medicaid reimbursement, and teaches development of comprehensive care plans. Using a pre/posttest design, participants' knowledge, attitudes and behaviors within the domains of transitional care, functional assessment, interdisciplinary team, community resources, and reimbursement were assessed. Of 103 students, 99.0% attended Session 1 and 97.1% attended Session 2 (pretest completion rate 99.0%, posttest 94.1%). Significant improvements were found in all domains, with the largest gains seen in transitional care. After the intervention, 56.0% identified medication errors as the most common source of adverse events after discharge (vs 14.9% before the intervention, P<.001). Significantly more participants reported feeling competent or expert in safely discharging chronically ill patients (66.3% vs 9.8%, P<.001) and in educating patients about discharge medications (75.8% vs 28.4%, P<.001). Participants also reported changes in transitional care behaviors (e.g., 71.6% now review the discharge medication list with patients and caregivers > or =50% of the time (vs 42.3%, P=.002)). A multimodal educational intervention for medical students increased their transitional care knowledge, reported frequency of transitional care behaviors, and perceived competence in managing the discharge process.