A Quality Improvement Initiative to Improve After-visit Summary Distribution in Orthopedic Outpatient Clinics

Abstract

Introduction: Communication and patient education are key to effective healthcare encounters and improved health outcomes. The after-visit summary (AVS) is an integral communication and education tool for patients and families. Without effective communication, gaps in comprehension may result in decreased satisfaction with medical encounters, lack of adherence to recommended treatment plans, missed appointments, and increased malpractice claims. Methods: We initiated a quality improvement (QI) initiative implementing concepts derived from the Institute for Healthcare Improvement (IHI) model, including plan-do-study-act cycles, to increase AVS distribution rates in a high-volume, fast-paced ambulatory pediatric orthopedic clinic. Interventions included staff education and training, trainee instruction, enlistment of electronic medical record superusers to enhance the distribution process, and provision of regular, transparent communication of individual and team performance. The impact of interventions was measured using a p-chart. Results: There was a consistent improvement in the rate of AVS distribution with each intervention implemented. The distribution rate on project initiation was 81.9%, with a final rate of 95.7%. The most statistically significant shift occurred following the final intervention, which included sharing unblinded individual performance data. Conclusion: Our data demonstrate that a dedicated QI program using IHI methodology improved AVS distribution rates in a pediatric orthopedic clinic. Consistently distributing the AVS affords our patients and families a better opportunity to review pertinent visit information, education, medication changes, and upcoming appointments.

A Quality Improvement Project to Improve After-visit Summary Patient Instructions in a Pediatric Multidisciplinary Neuromuscular Program

“…As noted by Williamson et al, healthcare workers are more invested in interventions when provided with real-time feedback and a way to appreciate their progress visually. 16 Periods of decreased completion rates corresponded with times when feedback was not being provided to clinicians, highlighting the pivotal role of education and reinforcement in sustaining these goals. Functionally, the EMR did not consolidate the AVS of several providers for one patient into one composite document.…”

“…Yet, limited literature addresses maximizing its effectiveness in pediatric populations or the unique context of multidisciplinary clinics. [14][15][16] Although the AVS has the potential to facilitate shared decision-making and effective communication, some studies have shown its design is not consistently optimized to convey valuable information clearly and understandably. 17 One primary challenge in patients' adoption and use of AVS patient instructions is the presence of medical jargon within providers' documentation.…”