Grantee Institution: Wake Forest Baptist Medical Center
Project name: Improving Transitions of Care for Older Adults through Interdisciplinary Education for Medical Residents
Principle Investigator: Franklin S. Watkins, MD
Overview: This project proposes to develop an Acute Care for the Elderly Unit Transitional Program (ATP) to teach optimal discharge planning and reinforce interdisciplinary communication through trainee home visits to vulnerable older patients after hospital discharge. The ATP will provide a “living laboratory” to enhance the medical trainees’ understanding of the importance of appropriate discharge planning, communication with the patient, family and caregivers, as well as impact a culturally and socioeconomically diverse population. Additionally, the ATP will meet the stated missions of both the Picker Institute and the Gold Foundation and will provide an innovative educational curriculum for continued measurement of important markers of medical residents’ knowledge, their attitudes regarding both transitions of care and interacting with older adults and their families, and patient outcomes. Successful hospital discharge and transitions of care can be considered Always Events, as all patients experience at least one (and often multiple) care transition following hospitalization.