Follow‐up appointments are a crucial part of the discharge home. This step can be time consuming as physicians try to navigate each outpatient office's unique system. In 2008 one of our interns identified the need for help in scheduling patient appointments. A time–motion study confirmed that 25% of an intern's day is spent on discharge planning. Simultaneously, our institution aimed to improve transitions of care and identified the postdischarge appointment as a key piece to understand.
To create and implement a centralized discharge appointment service for scheduling of postdischarge follow‐up appointments.
Starting in late 2008 we partnered with BIDMC's outpatient referral office, Care Connections (CC). Nurses in this office help referring doctors identify new specialists at BIDMC and maintain the provider directory. As a result, the staff is expert in triaging and accessing outpatient appointments. In late 2008, 2 interns per month were asked to identify the physician, timing, and rationale in appointment requests. We quickly learned several things. Identified primary care providers (PCPs) were occasionally inaccurate. Some patients had existing specialists and did not require new doctors in follow‐up. Frontline providers were also unaware of how patient insurance affects follow‐up options. As a result, inappropriate appointments were being made. We intervened in several ways. For every request, CC nurses now call and confirm the PCP, verify insurance information, identify existing outpatient specialists, and work with house staff and clinics to triage urgent appointments. All patient information systems are also updated. We utilized the traditional PDSA approach to improving and spreading our innovation. Over 2 years the program has grown from supporting 2 interns to every medical house officer team and the nonresident hospitalist service. We continually elicit feedback from users to improve. We began with a fax request sheet but then transitioned to our computerized physician order entry system. Completed appointment information is now easily imported into discharge instructions in patient‐friendly language. Service‐specific clinical follow‐up guidelines have developed. Penetration has steadily grown to approximately 60% of discharges. CC handles 250–300 appointment requests weekly. Instead of an average of 11 minutes per appointment, interns now spend approximately 5 minutes per entire discharge on appointments. Interns report being able to spend more time with their patients. Existing PCPs and specialists are pleased with the continuity of care. This growth of the service was achieved with the addition of 1.25 nurses FTE.
Although time and service needs were our initial motivators, we have also been able to improve the quality of this crucial piece of discharge planning. By centralizing our service, we have been able to “scale up” with fewer resources and have leveraged the “institutional knowledge” that this group of nurses holds.
A. Tess ‐ none; S. O’Neill ‐ none; J. Yang ‐ none
To cite this abstract:Tess A, O’Neill S, Yang J. Discharge Appointment Service: Supporting House Staff and Improving Transitions of Care. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 215. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/discharge-appointment-service-supporting-house-staff-and-improving-transitions-of-care/. Accessed January 18, 2020.