Skip to main content

Table 3 Supporting quotes

From: Striving toward team-based continuity: provision of same-day access and continuity in academic primary care clinics

Quote number

Category

Quote

Approaches to Providing Continuity: Coverage for Residents Absent from Clinic

1

Team-based continuity beneficial for both training and patient care

“Workarounds…for [urgent] access…just…adding…another resident to see patients…is not really patient-centric [and] it doesn’t engage the house staff in following those patients.” (Site A)

2

NPs, PAs, NP trainees, or RNs, not just medical residents and attendings, were included in coverage algorithms.

“…each one of our PA’s is assigned to one of the…PACT teams…the residents are all spread out among the teams…when…possible [residents] try to stick with the same PACT team for continuity” (Site M)

3

About half of participating clinics expected residents to address urgent between-visit needs.

“…we want to…encourage [residents] and help them to have a lot of ownership of these patients…there’s an expectation that they communicate with their LPN and their RN, the LPNs do a really nice job of paging them or texting them if a patient…needs to be taken care of promptly…” (Site S)

Barriers to Providing Team-based Continuity

4

Residency Program-related:

Low predictability of resident schedules.

“P: …when the resident’s not in clinic, they see their co-team resident and if no one on their co-team is available, then we put them in with any resident.

I: How often do you think a co-team resident is there?

P: It’s just hit or miss because it’s so up in the air” (Site D)

5

Residency Program-related:

Low predictability of resident schedules.

“especially with the residency requirement and…the demand on the residents from the inpatient setting, it’s been very, very challenging to build any kind of cohesive system of continuity…care, and consistency of having the…resident in clinic.” (Site C)

6

Residency Program-related:

Block model may increase schedule predictability

“sites that have [gone to the block model]…in terms of…predictability of schedules, access…people know when residents are going to be there and not be there… the residents themselves are also much happier.” (Site C)

7

Clinic-related:

Attendings with duties that took them away from clinic.

“…they’re doing teaching at the medical school…running the educational portion of the resident inpatient rotation…homeless shelter work…they’re more complicated in terms of the scheduling and making sure we have adequate coverage…” (Site O)

8

Teaching continuity beneficial to training and patient care

“Having that attending-resident continuity is very helpful in teaching...we can actually teach the residents how to improve as doctors…that helps overall patient care always.” (Site D)

9

Clinic-related:

Access pressure that limited attendings’ availability to see their residents’ walk-in patients.

“P: 10 attendings that…have interns and residents…are all in clinic today, no intern or resident is in clinic today.

I: If a resident’s patient comes in on a day where that resident’s attending is there, is there any effort [made for the patient to see the resident's attending]?

P: If the attending has access, but 10 times out of 10 that attending doesn’t have access” (Site B)

Adaptations to Increase Continuity

10

NP trainees, along with two resident partners, cross-cover each other.

“…if [resident] X is not here, then his physician partner will be with his patient. If that physician partner was not here, the nurse practitioner partner would see the patient. If that person is not available, then the back-up nurse practitioner would see the patient” (Site P)

11

Huddles increase informational continuity among team members.

“…trainees feel like when they have the complex patients who are coming in frequently, you’d much rather them come to a partner than a random person who doesn’t know their story… then we could talk about it in the huddle and make a plan and all be on the same page” (Site P)

12

Residents share a patient panel

“… [we could] have 6 or 8 residents that…[have] a relatively full-time presence in the clinic…and there’s continuity and they cross-cover… they team up to provide this really nice patient-centered level of care…they learn how to collaborate and they depend on each other…” (Site C)

13

RNs available for follow-up after huddling with team.

“…that’s the whole benefit of having pre-clinic huddles…there is a lot of communication…especially between the residents and their RN care managers. The RN care manager takes care of a lot of issues in between visits.” (Site A)