For a quarter of residents, responsibility ends with patient discharge

Patient in wheelchair entering car

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Once a patient is discharged from a hospital, the game is over for slightly more than one-quarter of internal medicine residents, a recent study found.

Based on a nationwide survey of almost 470 residents, 26.1 percent indicated that their responsibility for patients ends when they leave the hospital, according to the study published in the Journal of General Internal Medicine. That finding could have implications on hospital readmissions and transitions of care. More than half of U.S. hospitals will be hit by Medicare for excessive 30-day readmission rates this year, according to a recent analysis.

However, residents’ views on their responsibility after the discharge of a patient do vary widely, the study found. A smaller number (19.3 percent) said their responsibility extended 15 to 30 days after discharge. And more than half of residents (57 percent) said it was their responsibility to directly contact patients’ primary care providers at hospital discharge, with 21.6 percent saying it is their duty to ensure that patients attended their follow-up appointments.

Researchers surveyed residents at nine university and community-based internal medicine training program in the United States. They found factors including residents’ level of training, program type, career path or presence of burnout did not make a difference in their perceived responsibility for patients. Instead, they suggested that factors such as professional role modeling may shape residents’ perceptions of their post-discharge responsibility.

The study does raise questions about the shared responsibility among providers after a patient’s discharge, writes Shobha W. Stack, M.D., from the University of Washington Medical Center in Seattle, in an accompanying commentary.

Residents were not necessarily wrong in perceiving that their responsibility ended at discharge, 7 days, or 30 days later, because there are no firm rules when it comes to transition issues, Stack says. Of most importance is the patient.

"In the period between hospital and clinic, whom should the patient call if they have questions about their discharge medications? Whom should they call if a new issue arises? The answer lies less in a number and more in cultivating a teachable attitude of collaboration between hospitalists and primary care providers throughout this vulnerable time," she writes.