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

Improving plan of care communication between primary resident teams and nursing staff

BACKGROUND Ineffective communication between physicians and nurses can compromise patient care. The aim of this project was to encourage resident physicians to provide daily, verbal updates to nursing staff regarding their patients\u27 daily plan of care. METHODS The study took place at the George Washington University Hospital. It involved five internal medicine resident teams and the nursing staff on 4-South. Baseline data was collected with a questionnaire that assessed the number of patients that the nurses received a verbal plan of care. PDSA cycle 1 was distributing the nursing radio frequency phone numbers to the residents before morning rounds, and PDSA cycle 2 was posting a written reminder in the team rooms to call with the following details: diagnosis, goals for the day, labs or procedures, and discharge status. Post-intervention data was obtained with the same questionnaire used at baseline. RESULTS Our data did not show a significant increase in the amount of plan of care updates given by the resident teams to the nursing staff. Baseline and intervention data were each collected over a course of 4 days. At baseline, there were a total of 5 reports called to the 31 nurses that completed the survey. During PDSA cycle 1 and 2, a total of 7 reports and 5 reports were called to the 33 and 36 nurses who filled out the survey, respectively. Of note, a separate survey was performed amongst the nursing staff identify the specifics to include in the plan of care update. CONCLUSION The benefits of constructive communication between physicians and nurses is well established in both medical and nursing literature. Literature reviews have found that physicians and nurses hold different attitudes regarding the importance and quality of such collaboration (1). Our experiences underscore this effect when considering the differences in what physicians felt was most important (providing a daily care plan update) and what nurses felt was most important (and expanded list, covering diagnosis, lab and procedure updates, and discharge planning). High workloads and burnout (2) are commonplace in residency, and may have had an adverse effect as resident physicians may have felt too overburdened to take on any additional responsibilities or allocate any more time from their already long work days to engage in collaborative efforts with the nursing staff. Future research should focus on the barriers to physician-nurse communication and collaboration, and identify ways to address them