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ABSTRACT
Planning and coordination among health-care professionals decrease readmission rates, yet workers have few opportunities to learn interprofessionally to improve transitions of care. An interprofessional readmission review curriculum engaged medical residents, pharmacy residents, nurse practitioner students, early-career nurses, and social work students in a critical analysis of readmissions. Learners (N = 98) participated in a 2 h, collaborative learning session to review health records from a patient readmitted within 30 days of discharge and determine plausible root causes for readmissions. A 5-item post-session survey completed by 83 (85%) evaluated knowledge and perceived competencies in transitions of care before and after participation. Significant improvements (p < .001) occurred in ratings for all five items. Two open-ended questions captured learners’ perceptions of understanding and appreciating the roles of other disciplines in the discharge process and importance of interprofessional communication. Several themes emerged including understanding gaps in the discharge process, improving interprofessional collaboration and communication, and paying more attention to discharge documentation. This innovative program helped build essential skills to ensure safe discharges by introducing learners to interprofessional perspectives in analyzing root causes for readmissions, strategies to improve discharge planning, and the value of team-based care.
Acknowledgments
The authors would like to acknowledge the nurses, pharmacists, social workers, and medical residents at the Hospital of the University of Pennsylvania who participated in this novel curriculum and helped shaped the future direction of the curriculum.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
Supplementary material
Supplemental data for this article can be accessed publisher’s website.
Additional information
Notes on contributors
Lindsey Merrihew Haddock
Dr. Lindsey Merrihew Haddock is a resident in Internal Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA
Mark Upton
Dr. Mark Upton is a Staff Physician at Crescenz Philadelphia VA Medical Center
Rosemary C. Polomano
Rosemary C. Polomano is a Professor at the University of Pennsylvania School of Nursing, Philadelphia, PA.
Jennifer S. Myers
Jennifer S. Myers is a Professor at the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Deepa Rani Nandiwada
Dr. Deepa Rani Nandiwada is an Assistant Professor at the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Rachel K. Miller
Rachel K. Miller is an Associate Professor at the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.