311 - Augmenting Autonomy and Implementing Educational Resources Increases Resident Competency and Confidence Managing Direct Admission and Interfacility Transfer Processes at a Tertiary Children’s Hospital

Poster Number: 311
Publication Number: 311.322

Jordan H. Vaughan, University of California San Francisco, San Francisco, CA, United States; Reena Tam, University of Utah School of Medicine, Salt Lake City, UT, United States; Christopher Miller, University of Utah School of Medicine, Salt Lake City, UT, United States; Kristin W. Vaughan, University of Utah, Salt Lake City, UT, United States

Background: Direct admissions (DA) and interfacility transfers (IFT) are common in hospital medicine, representing a critical transition of care and requiring a unique communication skill set. Resident education in these domains is lacking, with a paucity of literature on the subject. We surveyed recent graduates from the University of Utah Pediatric Residency; of the 55 respondents, 18% agreed they received formal training or autonomy in managing DA/IFTs, while 67% agreed such training would have better prepared them for fellowship or attending practice.

Objective: Improve pediatric resident self-reported competencies and confidence in managing direct admission and interfacility transfer processes without compromising efficiency of referral triage. 

Design/Methods: Pediatric trainees rotating as the admitting resident (AR) were provided DA/IFT educational resources and a validated note template was incorporated into the EMR to guide triage. Autonomy was augmented with residents leading all DA/IFT referral calls under hospitalist supervision with feedback post-hoc. Residents completed pre- and post-rotation surveys, self-assessing knowledge and confidence in key domains. Duration of referral calls was used as a balancing measure.

Results: Responses to 8 survey questions were measured using Likert-scales. Residents were more likely to agree with the key statement, “I would feel confident independently managing a phone call from a referring provider to directly admit/transfer a patient to the pediatric hospitalist service,” after the AR rotation (median=4, agree) compared to before (median=3, neutral) (Mann-Whitney U=149, n1=27, n2=24, P=0.001). Remaining questions assessed competency in fundamental DA/IFT domains and showed similar improvement (Table 1). Average referral call duration did not change from pre-intervention (Figure 1).Conclusion(s): Direct admissions and interfacility transfers are frequent and important transitions in care that receive little attention in medical training. When provided dedicated education and increased autonomy in leading DA and IFT referrals, senior residents report greater confidence and competence in their ability to manage such referrals, doing so efficiently without prolonging duration of referral calls.  Limitations include lack of objective evaluation of resident abilities and inability to correlate the intervention with patient outcomes.
Table 1. Mann-Whitney U Analysis of Resident Self-Assessment Tool Using Likert-Scales Before and After Educational InterventionNote. Likert scale responses: 1= strongly disagree, 2= disagree, 3= neutral, 4= agree, 5= strongly agree
a: n1 = 24. b: n2 = 27. c: U-Crit for all questions = 219
* p < 0.05 ** p < 0.01
Figure 1. Average Duration of Direct Admission and Interfacility Transfer Referral Calls by MonthNote. Average monthly call duration (minutes) during 8-month period before and after intervention rollout. Call duration after intervention (M=11.32, SD=2.63) did not differ from pre-intervention (M=12.24, SD=2.24), t(7)= 2.36, p=0.31.
a: Average call duration over 16 month study period = 11.78 minutes