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More than 25% of internal medicine residents say patient responsibility ends at discharge

Internal medicine residents are uncertain about the duration of their responsibilities for patients who have been discharged, according to survey results published in the Journal of General Internal Medicine.

Eric Young, MD, from the University of Colorado, Anschutz Medical Campus, acknowledged that this variability can lead to a responsibility gap for patients who have been recently discharged, "in which the delineation between inpatient and outpatient provider responsibilities is undefined."

"Perceived responsibility is essential for ensuring that discharging providers adopt the transition of care practices outlined in consensus guidelines," Young and colleagues wrote. "The theory of planned behavior argues that an individual's decision to adopt a specific behavior is dependent upon three factors: social pressure, perceived self-efficacy, and his or her fundamental attitude towards that behavior. It therefore stands to reason that if a clinician does not possess an attitude of responsibility for patients after they leave the hospital, he or she will be unlikely to adopt the often time-consuming practices required to optimize post-discharge care."

The researchers conducted a multisite, cross-sectional study in which they administered a 24-question survey to 817 internal medicine residents at nine university and community-based internal medicine training programs. They reported responses from 469 participants.

Results showed that 26.1% of residents responded that patient responsibility ended at discharge and 19.3% responded that responsibility lasted longer than 2 weeks. In addition, 85.1% to 99.3% of residents agreed or strongly agreed that they were responsible for six of eight care transition activities, which included medication reconciliation, lab follow-up, post-discharge follow-up and communication with follow-up providers. Further, 21.6% of internal medicine residents responded that it was their responsibility to ensure patients attended a follow-up appointment after discharge and 57% responded that it was their responsibility to call or email a patient's primary care provider at the time of discharge.

Young and colleagues noted that perceived responsibility duration was not associated with burnout, training level, program type or career path.

"In this national survey, internal medicine residents demonstrated notable variability in perceived duration of responsibility for recently discharged patients," Young and colleagues concluded. "Neither the duration nor the content of residents’ perceived responsibility was consistently associated with level of training, program type, career path, or burnout, suggesting that there may be unmeasured factors such as professional role modeling that shape these perceptions." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.