Improving Post-Hospital Transitions of Care by Facilitating Follow-Up Appointment Creation

Background: Transitions of care are important to patient safety and care. They are a known period of risk and often patients can suffer an adverse event, resulting in hospital readmissions. Within the George Washington University Hospital, data has shown that over 50% of patients admitted to the internal medicine wards that are readmitted within 1 month do not have a follow-up appointment scheduled prior to initial discharge. A study at the University of Colorado Hospital showed that patients lacking timely follow-up after an inpatient stay were ten times more likely to be readmitted. Our project aims to improve the rate of follow-up appointments made and documented by 25%. Methods: Baseline data was collected in December 2015 from four internal medicine wards teams tracking the number of daily patient discharges, follow-up appointments, and time to follow-up appointment from discharge. Our intervention was to provide all internal medicine wards team members with local clinics’ contact information. Data was again collected after the intervention as a comparison. Results: Baseline data identified 50 patients that were discharged from medicine teams. Average length of stay was 13.5 days. 19 patients (38%) had follow-up appointments made at time of discharge. Average time from discharge to appointment date was 15 days. After the intervention, 58 patients were discharged from medicine teams. Average length of stay was 4.8 days. 36 patients (62%) had follow-up appointments made at time of discharge. Average time of discharge to appointment date was 8 days. Conclusions: By providing internal medicine residents with contact information for local clinics, we were able to increase the percentage of patients who have appointments made at time of discharge by 24%. Results also show a decrease in the average time from discharge to appointment date, indicating timelier follow-up. The next steps will be to determine if this correlates to a reduction in readmission rates, which are costly to both the hospital and the patient

Beyond treatment - Psychosocial and behavioural issues in cancer survivorship research and practice.

The population of cancer survivors has grown steadily over the past several decades. Surviving cancer, however, is not synonymous with a life free of problems related to the disease and its treatment. In this paper we provide a brief overview of selected physical and psychosocial health problems prevalent among cancer survivors, namely pain, fatigue, psychological distress and work participation. We also address issues surrounding self-management and e-Health interventions for cancer survivors, and programmes to encourage survivors to adopt healthier lifestyles. Finally, we discuss approaches to assessing health-related quality of life in cancer survivors, and the use of cancer registries in conducting psychosocial survivorship research. We highlight research and practice priorities in each of these areas. While the priorities vary per topic, common themes that emerged included: (1) Symptoms should not be viewed in isolation, but rather as part of a cluster of interrelated symptoms. This has implications for both understanding the aetiology of symptoms and for their treatment; (2) Psychosocial interventions need to be evidence-based, and where possible should be tailored to the needs of the individual cancer survivor. Relatively low cost interventions with self-management and e-Health elements may be appropriate for the majority of survivors, with resource intensive interventions being reserved for those most in need; (3) More effort should be devoted to disseminating and implementing interventions in practice, and to evaluating their cost-effectiveness; and (4) Greater attention should be paid to the needs of vulnerable and high-risk populations of survivors, including the socioeconomically disadvantaged and the elderly