Bridging the Gap: Virtual Interprofessional Education on the Hospital‐to‐Skilled Nursing Facility Transition

Care transitions, including the hospital-to-skilled nursing facility (SNF) transition, are complex and error-prone [1]. Interprofessional collaboration can promote effective and safe patient care in care transitions. Therefore, preparing healthcare professions learners for interprofessional collaboration in the setting of care transitions is important. Currently, there are limited examples of interprofessional education (IPE) within the topic of care transitions, and none have focused exclusively on the patient and system complexity present in hospital-to-SNF transitions [2-4]. We developed an IPE curriculum, embedded within an existing clinical program, for interprofessional learners to (1) acquire increased knowledge of care transitions, (2) appreciate collaboration among members of the interprofessional team, and (3) identify safety gaps in the hospital-to-SNF transition. The purpose of this paper is to describe the implementation and results of this curriculum. The “TeleHOPE” (Health Optimization Program for Elders) clinical program was developed in 2019 to promote safe transitions for patients recently discharged from our hospitals to participating skilled nursing facilities. TeleHOPE consists of weekly teleconferences in which our health system-based team meets with local SNF teams to discuss patients discharged within the previous week and to address any gaps in their transition. Leadership from the TeleHOPE program reached out to educators to collaborate on an educational component to the program. Educators formed a team, developed the curriculum objectives noted above, and recruited learners from various professional schools to participate. The recruited learners included clinical nurse specialist students, nurse practitioner students, physical therapy students, pharmacy students, medical students, and Internal Medicine and Family Medicine residents. Most learners participated voluntarily, as scheduling complexities made it difficult for schools to require participation or offer credit. Learners participated in three activities over a one-week span. First, learners completed a 45-min online module highlighting the complexities of care transitions and important intervention strategies for transitions via a fictional patient case. Second, learners participated in a virtual case-based session facilitated by a Geriatric Medicine fellow and/or a Geriatrician. This session introduced interprofessional competencies, followed by discussion of a TeleHOPE patient scheduled for the weekly teleconference. During the case discussion, the learners generated a list of questions and concerns regarding the patient's transition, which was then sent to the clinical team for the TeleHOPE conference the next day. Third, the learners observed the TeleHOPE conference. All learners were invited to complete a post-survey immediately after their TeleHOPE participation. The survey included three open-ended questions prompting learners to reflect on (1) a learning point to apply to their practice, (2) what surprised them, and (3) suggestions for curriculum improvement. Two authors used inductive coding to review the data and identify themes in the response, then calculated the percentage of responses that included each theme. This educational program was determined to be exempt as non-research by the Duke Health IRB. In the program's first year, 54 learners completed the curriculum, including 24 clinical nurse specialist students, 12 medical residents, 8 pharmacy students, 6 nurse practitioner students, 3 medical students, and 1 physical therapy student. Most learners participated in the activities during 1 week only. Each week, between 1 and 6 learners participated. During the case-based session, each group of learners contributed an average of six questions or concerns related to safe transitions. Self-identified learning points identified fell into three themes: (1) the need to personally improve hospital discharge tasks, (2) appreciation of collaboration and communication, and (3) new knowledge about the care transitions process (Figure 1). Forty-six percent of respondents indicated the need to improve their own discharge tasks, including improving written and verbal communication, paying closer attention to medication reconciliation, and providing more comprehensive patient education (see Figure 1 for learner quotes). Thirty-six percent of respondents reflected on the importance of communication and collaboration among healthcare professionals, often regarding patient safety. Finally, 13% of respondents commented on new knowledge they gained related specifically to care transitions. These comments included new knowledge on post-hospital care settings and the roles of other healthcare professionals. Three themes arose in the learners' reflections on what surprised them: (1) the considerable number of healthcare professionals involved in transitions, (2) the presence of numerous gaps and errors in care transitions, and (3) the important role that pharmacists play on an interprofessional team. One learner commented: “It was surprising to learn how simply moving from one facility to another can cause treatment gaps and that there are so many things to consider to have seamless handoffs.” Suggestions for curriculum improvement centered around increasing the number of learners present at the case-based session and increasing learner engagement in the TeleHOPE conference. This virtual, case-based, IPE program successfully brought learners from diverse professions together to learn about interprofessional collaboration and the hospital-to-SNF transition. The learners' reflections demonstrated that we met all curricular objectives including increasing knowledge of care transitions, fostering appreciation for interprofessional collaboration, and identifying safety gaps. While the curriculum did not focus on motivating learners to improve specific hospital discharge tasks, we were pleased that many learners recognized areas for personal improvement. We attribute much of the curriculum's success to the integration of learning activities within an existing clinical program. By centering the activities around the TeleHOPE conference, learners observed firsthand the complexity of the hospital-to-SNF transition and contributed to the identification of possible errors in real patient cases. We were limited by logistical challenges. Recruitment of learners from some schools was difficult and this occasionally led to limited numbers of learners at the case-based sessions. Additionally, the weekly offering was time-intensive for the two facilitators. Going forward, we are offering the curriculum on a monthly basis, both to increase the number of learners and to reduce the facilitators' time commitment. Next steps include having learners take a more active role in the TeleHOPE conference by presenting the patient reviewed in the case-based session. In addition, we plan to expand our assessment to include pre-participation surveys and to further evaluate the impact of this curriculum on learners' perceived attitudes and behaviors after their participation. In contrast to traditional clinical experiences that only include a one-sided involvement in transitions, this unique curriculum provided learners a comprehensive view of the hospital-to-SNF transition process and instilled the importance of interprofessional collaboration for safe and effective patient transitions. Design: All authors. Data collection and analysis: Collin Burks, Mamata Yanamadala, and Camila Reyes. Manuscript drafting and editing: All authors. The authors have nothing to report. The authors declare no conflicts of interest.