What was known Following their continuity patients after a hospitalization is challenging for internal medicine residents, and experiential learning in care transitions is limited.;What is new A resident discharge clinic increases access to early posthospitalization follow-up and provides opportunities for resident learning.;Limitations Small sample and nonvalidated survey tool.;Bottom line A resident-staffed discharge clinic teaches residents about care transitions and improves patient access to posthospital care.;Editor's Note: The online version of this article contains the resident discharge clinic checklist and residents' survey on posthospitalization follow-up for resident-clinic patients.;Introduction Posthospitalization care is challenging for many patients in internal medicine (IM) resident continuity clinics due to difficulty accessing care, which can result in delayed follow-up, missed test results, medication errors, hospital readmission, or emergency department visits.1–6 Studies of early posthospitalization follow-up have shown reduced 30-day readmission rates and emergency department visits; however, these interventions have not been applied to resident continuity clinic patients.7–9 To improve postdischarge care in teaching hospitals, residents need training in evidence-based postdischarge practice, particularly learning about care transitions.10 Most existing transitions-in-care curricula focus on inpatient-to-inpatient handoffs.11 Discharge interventions in some IM residency programs have focused on the quality and timeliness of discharge summaries,12,13 but improving the inpatient-to-outpatient handoff involves multiple factors. A study of IM residents identified a lack of postdischarge feedback and formal training as a barrier to high-quality posthospital care in teaching institutions.14,15 Another study suggested that a clinical experience in posthospital follow-up care may improve residents' discharge practices.16 In 2011 at the University of Chicago, IM and medicine-pediatrics (MP) residents perceived difficulty in obtaining posthospitalization follow-up in the resident clinics as a barrier to patient care. In addition, there was no structured resident curriculum on postdischarge care. To address these needs, we created a resident discharge clinic (RDC) to provide a platform for structured experiential learning in posthospital care transitions and to improve patient access to postdischarge appointments. Here we describe the RDC design, our initial experience, the impact on access to posthospital care, and next steps.;Methods Setting and Participants The University of Chicago has more than 90 IM and MP residents. Each resident is a primary care provider for approximately 100 patients by the end of their training. In the traditional clinic model, residents were in clinic 1 half-day each week and had several consecutive weeks with no clinic sessions because of inpatient service obligations. The sample for this study consisted of adult patients (18?years and older) who were deemed eligible for the RDC if they had an established relationship with the resident continuity clinic and were discharged from the University of Chicago Hospital or an affiliated community hospital. Patients with a faculty primary care provider and patients who had not been followed in the resident clinic before their hospitalization were excluded.;Results During the first 6?months of the RDC, 24 clinic sessions were staffed by 24 residents. There were 122 available appointments, 56 (46%) of which were filled with posthospitalization visits. Of the 56 scheduled appointments, 22 visits were not completed (39% no-show rate). There were no major differences in age, sex, or length of hospital stay among baseline, intervention, and RDC patients (table?1). Patients seen in the RDC had improved timeliness of posthospital care, but 30-day readmissions did not differ from that of the other 2 groups (table?2). View larger version (26K) TABLE 1Uni
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