Mind the Gap: A Novel Care Transitions Curriculum for Hospitalists and Residents.

Care transitions—which occur when a patient moves from the intensive care unit to the medical floor, from the hospital to a skilled nursing facility or home, or from one team to another—represent high-risk periods for adverse events. These transitions are more complex in older patients. Notably, almost half of patients 85 years and older, and 30% of patients 75 to 84 years old, are discharged to a skilled nursing facility. Potential adverse events in this setting include medication errors, poor communication with the patient and receiving providers, and loss of follow-up of pending tests. Improving these transitions requires an interdisciplinary approach to education and information exchange among hospitalists, trainees, and postacute care teams.