SHM Converge Scientific Abstract ePoster Gallery-Variation in Hospitalist Medication Reconciliation Practices in Multi-Handoff Settings: A Qualitative Study

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This qualitative study examined how hospitalists at a large urban academic hospital approach prior-to-admission (PTA) medication reconciliation in multi-handoff inpatient care. The authors focused on three hospitalist roles: direct-care, swing-admitting, and night-admitting clinicians, because role-based differences in medication reconciliation have not been well characterized.

Using three focus groups and inductive content analysis of discussion notes, the study found substantial variation in how clinicians verify medications, manage medication lists, and document their work. Nine direct-care hospitalists, four swing admitters, and seven nocturnists participated.

Three main themes emerged:

1. <strong>Verification approach varies by role.</strong> Some clinicians emphasized complete confirmation of all home medications, while others prioritized verifying only essential or safety-critical medications, especially overnight.

2. <strong>Medication list management differs.</strong> Clinicians varied in whether they discontinued, cleaned up, or left medication list changes for others to handle. Some avoided making changes when they lacked information about prior discussions with outpatient providers.

3. <strong>Documentation practices are inconsistent.</strong> Hospitalists used different methods to record medication status, including free-text notes, direct edits to the electronic medication list, and various EMR-based tools. This created ambiguity during handoffs.

Overall, the study suggests that unclear expectations and lack of standardized workflow lead to duplicate work, higher cognitive load, and inconsistent medication reconciliation outcomes. The authors conclude that defining role-specific responsibilities and standardizing workflows could improve the quality, accuracy, and reliability of PTA medication reconciliation in settings with multiple handoffs.

Asset Subtitle

Claire Howlett

Meta Tag

Author List Claire Howlett, Kala Ghooray, Kristen Kipps, Maham Awan, Molly A. Kantor, Robertino Garcia Cortes

Category Research

Concept Medication Reconciliation

Concept Prior-to-Admission Medication

Concept Process Standardization

Concept Inpatient Care

Concept Hospitalist

Distinguished Non-Finalist

Presenter Organization Columbia University

Presenting Author Claire Howlett

Track Quality Improvement

Keywords

medication reconciliation

prior-to-admission

hospitalists

inpatient care

handoffs

electronic medical record

medication verification

documentation practices

workflow standardization

qualitative study

Medication Reconciliation

Prior-to-Admission Medication

Process Standardization

Inpatient Care

Hospitalist