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Introduction: Hospital medicine is a growing field that focuses not only on expertise in inpatient medicine but also on knowledge of nonclinical health system topics. The traditional model for resident education does not lend itself to learning these topics. We developed a unique ward rotation with a dedicated curriculum called the Resident Inpatient Training Experience (RITE) to address this deficiency., Methods: The RITE rotation was initially implemented in the 2013-2014 academic year. The curriculum accompanying the rotation contained four case-based modules that included content on patient safety, quality improvement, cost-conscious care, hospital metrics/reimbursement, physician billing and coding, and transitions of care. Prior to RITE, residents received an email orientation to the service. To evaluate the rotation and curriculum, residents completed a pre- and postrotation online survey. Forty-six upper PGY 2 residents each rotated on the service for 1 month. An experienced hospitalist attended on the service and facilitated a weekly discussion on each module. This publication includes an updated version of the email orientation, the four modules, and the surveys., Results: There was a 72% response rate for completion of the pre- and postrotation survey. Confidence in managing hospitalized patients and knowledge of module content taught during the rotation improved., Discussion: We found that implementation of a hospital medicine rotation and curriculum improved resident independence and knowledge of the module topics and was a successful way to alleviate current deficiencies in resident education., (© 2020 Lin et al.)

Introduction: More medical schools are offering a transition-to-intern-year course to better prepare graduates for residency. Sessions where students simulate receiving cross-cover calls are frequently included and highly rated. However, simulated sessions are often resource intensive and therefore challenging to implement in all schools. We developed a case-based exercise to address this need., Methods: In 2009, our school implemented a required course focused on the transition-to-intern year, including a common overnight calls (COC) module. Students rotated through different stations in small groups which were each led by a facilitator. Topics have evolved in response to feedback, and current topics included altered mental status, chest pain, and other frequent calls., Results: Over 1,000 students have participated in the module. The students consistently reported that they perceived themselves to be more prepared for internship. Between 2009 and 2016, the mean rating of "the COC module helped prepare me for internship" was 6.29 on a 7-point Likert scale (1 = strongly disagree and 7 = strongly agree ). The 2017 data are limited. In 2018 and 2019, students continued to feel more prepared for their intern year, 4.72 in 2018 and 4.71 in 2019 on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree ). The students perceived the COC format as effective., Discussion: Small-group case-based classroom simulations are an effective way to improve students' perceived preparedness for responding to common overnight calls during intern year., (© 2020 Lescinskas et al.)

We conducted a prospective observational study of indications for use and patient experiences with midline catheters (n = 50) compared to peripherally inserted central catheters (n = 63). The primary indication for patients with midline catheters was difficult venous access. Patients with midline catheters reported fewer complications than patients with peripherally inserted central catheters.

Background: Little is known about the patient experience with urinary catheters or peripherally inserted central catheters (PICCs). We sought to better understand patient perspectives on having a urinary catheter or a PICC by reviewing open-ended comments made by patients about having either of these 2 devices., Methods: As part of a larger study, we asked patients about certain catheter-related complications at the time of catheter placement and on days 14, 30, and 70 (PICCs only). In this larger project, we performed a structured assessment that included an open-ended question about other comments (initial interview) or problems (follow-up interview) associated with the device. For the current study, we conducted a descriptive analysis of these open-ended comments, classifying them as positive, negative, or neutral., Results: Positive comments about urinary catheters accounted for 9 of 147 comments (6%), whereas positive comments about PICCs accounted for 10 of 100 comments (10%). Positive comments for both catheter types were mostly related to convenience. More than 80% of comments about both types of devices were negative and fell into the following areas: catheter malfunction; pain, irritation, or discomfort; interference with activities of daily living; provider error; and other., Conclusions: Our findings underscore the need to optimize the patient experience with placement, ongoing use, and removal of urinary catheters and PICCs., (Published by Elsevier Inc.)

Objective: Peripherally inserted central catheters (PICC) are frequently used to deliver medical therapies, but our knowledge regarding PICC-related complications remains incomplete. The objective of this study was to systematically elicit and characterise PICC-related complications as experienced by patients during and after hospitalisation., Design: Prospective cohort study., Setting: Inpatient medical units at four US hospitals in two states., Participants: Consecutive sample of patients who had a new PICC placed during a hospital stay between August 2015 and May 2017., Main Outcomes: Patient-reported signs and symptoms of a possible PICC-related complication or functional issues., Results: Of the 438 patients in the analytic cohort (91.4% of those consented), two-thirds were male with a mean age of 56 years. The most common reason for PICC placement was long-term antibiotic therapy (43.4%). During the 70-day follow-up period, 61.4% of patients reported signs of at least one complication, including potentially serious complications, such as bloodstream infection (17.6%) and deep vein thrombosis (30.6%). Correspondence of these reported events with medical record documentation of the complication was generally low. More than one-quarter (27.9%) of patients reported minor complications, such as insertion site redness, discomfort or difficult removal. While the PICC was in place, 26.0% reported restrictions in activities of daily living, 14.4% social activity restrictions and 19.2% had difficulty with flushing or operating the PICC., Conclusion: Over 60% of patients report signs or symptoms of a possible complication or adverse effect after PICC placement. Bothersome complications from the patient perspective are clearly more common than those that typically rise to the level of healthcare provider attention or concern. Understanding the patient experience is critical for providing safe and effective care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

To assess complications of condom catheters compared with indwelling urethral catheters, we conducted a prospective cohort study in two Veterans Affairs hospitals. Male patients who used a condom catheter or indwelling urethral catheter during their hospital stay were followed for one month by interview and medical record review. Participants included 36 men who used condom catheters and 44 who used indwelling urethral catheters. At least one catheter-related complication was reported by 80.6% of condom catheter users and 88.6% of indwelling catheter users (P = .32), and noninfectious complications (eg, leaking urine, pain, or discomfort) were more common than infectious complications in both groups. Condom catheter patients were significantly less likely than indwelling catheter patients to report complications during catheter placement (13.9% vs 43.2%; P < .001). Patients reported approximately three times more noninfectious complications than the number recorded in the medical record.

Background: The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program requires residents to receive training in handoffs, but there is limited information on best practices in implementing handoff training., Objective: We hypothesized that a bundled, standardized approach to handoffs during intern orientation would increase trainee comfort, confidence, and knowledge., Methods: All incoming internal medicine interns participated in a Care Transitions workshop during orientation that was divided into 3 sections: introduction and handoff videos using the I-PASS handoff tool, small group discussion of case scenarios, and a 1-on-1 handoff simulation with an evaluator. Participants completed pre- and postworkshop surveys. We reviewed handoff documents to assess whether residents continued to report illness severity-a key component of I-PASS-after the intervention., Results: Over 3 years, 225 of 229 (98%) interns completed the preworkshop survey, and 191 (83%) completed the postworkshop survey. Between 2014 and 2016, the number of incoming interns reporting prior training in handoffs during medical school increased from 45% to 63%. Interns' self-reported comfort with providing effective handoffs and self-reported confidence identifying factors essential to an effective verbal handoff (measured on a 5-point Likert scale) improved significantly after the intervention ( P < .05 for all questions and years). During 1 year, written handoffs for 28 498 patients were analyzed, and I-PASS illness severity was documented 99.4% of the time., Conclusions: The Care Transitions workshop consistently improved comfort, confidence, and knowledge of interns in performing handoffs and resulted in sustained change in handoff documentation., Competing Interests: Conflict of interest: The authors declare they have no competing interests.

Importance: Indwelling urethral catheters (ie, Foley catheters) are important in caring for certain hospitalized patients but can also cause complications in patients., Objective: To determine the incidence of infectious and noninfectious patient-reported complications associated with the indwelling urethral catheter., Design, Setting, and Participants: A prospective cohort study of consecutive patients with placement of a new indwelling urethral catheter while hospitalized at 1 of 4 US hospitals in 2 states. The study was conducted from August 26, 2015, to August 18, 2017. Participants were evaluated at baseline and contacted at 14 days and 30 days after insertion of the catheter about complications associated with the indwelling urethral catheter and how catheterization affected their social activities or activities of daily living., Exposures: Indwelling urethral catheter placement during hospitalization. Patients were enrolled within 3 days of catheter insertion and followed up for 30 days after catheter placement, whether the catheter remained in or was removed from the patient., Main Outcomes and Measures: Infectious and noninfectious complications associated with an indwelling urethral catheter as well as how the catheter affected patient social activities or activities of daily living., Results: Of 2967 eligible patients, 2227 (75.1%) agreed to participate at 1 of 4 study sites; 2076 total patients were evaluated. Of these, 71.4% were male; mean (SD) age was 60.8 (13.4) years. Most patients (1653 of 2076 [79.6%]) had short-term catheters placed for surgical procedures. During the 30 days after urethral catheter insertion, 1184 of 2076 patients (57.0%; 95% CI, 54.9%-59.2%) reported at least 1 complication due to the indwelling urethral catheter. Infectious complications were reported by 219 of 2076 patients (10.5%; 95% CI, 9.3%-12.0%), whereas noninfectious complications (eg, pain or discomfort, blood in the urine, or sense of urinary urgency) occurred in 1150 patients (55.4%; 95% CI, 53.2%-57.6%) (P < .001). Women were more likely to report an infectious complication (92 of 594 [15.5%] women vs 127 of 1482 [8.6%] men; P < .001), while men were more likely to report a noninfectious complication (869 of 1482 [58.6%] men vs 281 of 594 [47.3%] women; P < .001). Restrictions in activities of daily living (49 of 124 patients [39.5%]) or social activity (54 of 124 [43.9%]) were commonly reported by the patients who had catheters still in place; sexual problems were reported by 99 of 2034 patients (4.9%) after their catheter was removed., Conclusions and Relevance: Noninfectious complications of urethral catheters affect a substantial number of patients, underscoring the importance of avoiding urethral catheterization whenever possible. Given the high incidence of these patient-reported complications, urethral catheter-associated noninfectious complications should be a focus of surveillance and prevention efforts.

Objective: The goal of this study was to improve resident confidence in inpatient care and knowledge in hospital medicine topics with a newly developed rotation and curriculum called the Resident Inpatient Training Experience., Methods: This study was a prospective observational study completed by postgraduate year-2 (PGY-2) internal medicine residents in two affiliated hospitals. Forty-six PGY-2 residents each rotated on the Resident Inpatient Training Experience service for 1 month and completed a pre- and postrotation confidential online survey. Primary outcomes included confidence in managing hospitalized patients, knowledge regarding hospital medicine topics, and interest in pursuing hospital medicine as a career., Results: Thirty-three PGY-2 residents completed both the pre- and postrotation survey (72% response rate). After completing the rotation, the residents' confidence level (measured on a 5-point Likert scale, with 1 = strongly disagree and 5 = strongly agree) rose significantly in managing hospitalized patients, from 3.82 to 4.33 ( P = 0.003) and in leading a ward team, from 3.76 to 4.21 ( P = 0.020). Knowledge level (measured on a 5-point Likert scale with 1 = very poor and 5 = excellent) improved significantly in transitions of care, from 3.45 to 3.79 ( P = 0.023); cost-conscious care, from 3.00 to 3.42 ( P = 0.016); physician billing/coding, from 2.55 to 3.03 ( P = 0.007); hospital metrics, from 2.39 to 2.94 ( P = 0.002); and hospital reimbursement, from 2.48 to 3.09 ( P = 0.001). Interest in pursuing hospital medicine as a career also increased., Conclusions: Resident independence in managing patients and training in hospital medicine topics has not kept up with evolving need. Dedicated hospital medicine rotation and curriculum are effective ways to alleviate the deficiencies in resident education.