Pediatric Hospitalists Collaborate to Improve Timeliness of Discharge Communication

Abstract

Objectives: The transition of care from hospital to primary care provider (PCP) at discharge carries the potential for significant information loss. There is evidence that the timeliness and content of discharge communication are often unreliable during this handoff. Suboptimal transitions of care at discharge have been associated with adverse outcomes, and efficient solutions are required to transform the current state. Our specific aim was the achievement 90% documentation of hospitalist-PCP communication within 2 days of hospital discharge in <12 months. Methods: As part of a grassroots collaborative improvement organization, pediatric hospitalist groups engaged in parallel quality improvement projects to improve the timeliness and reliability of discharge communication at their local institutions. After an initial face-to-face meeting, e-mail and regular conference calls were used to promote shared effort and learning. The study period lasted 12 months, with >16 weeks of continuous data required for inclusion. Results: The mean rate of documentation of timely discharge communication across the collaborative increased from 57% to 85% over the study period. For the 7 hospitals that were able to collect >16 weeks of data before July 2010, the mean rate of communication was >90%. Participants reported that the context of the collaborative contributed to their success. Conclusions: Timely hospitalist-PCP communication was inconsistent at the beginning of the study. This low-resource quality improvement collaborative was able to achieve rapid improvement and resulted in improved perceptions of quality improvement knowledge among participants.

Linking Patient-Centered Medical Home and Asthma Measures Reduces Hospital Readmission Rates

“…At KMCWC, the Pediatric Hospitalist Division cares for ∼85% of all inpatients. They are committed to providing timely communication with the PCP at discharge 37 and facilitating continuity at the transition of care to the outpatient setting. Children without an identified PCP on admission are provided with a follow-up appointment with a new PCP before discharge.…”

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children

“…To date, the only published pediatric discharge improvement collaborative focused on improving communication to primary care providers after hospital discharge. 13 About 20% of older Medicare patients who are hospitalized are readmitted to the hospital within 30 days after discharge. 14 Because of the high cost of readmissions, adult hospitals with high readmission rates receive reduced Medicare payments under the Affordable Care Act.…”

Pediatric Post-Acute Care Hospital Transitions: An Evaluation of Current Practice

“…[16][17][18] Effective transition practices are needed to ensure patient safety [5][6][7][8][9]19 and patient/family readiness for admission to a postacute care hospital or discharge to the community from a post-acute care hospital. [9][10][11][12] Practices for transition include assessment, communication, education, and logistics.…”

“…[9][10][11][12] Practices for transition include assessment, communication, education, and logistics. [4][5][6][7][8][9][10][11][12]14,[19][20][21][22][23][24][25] Reports of transition practices for adults transferring to inpatient rehabilitation programs 7 and for infants being discharged after care in a NICU are available. 20,21 In addition, recommendations have been made for discharge planning for children who require mechanical ventilation.…”

“…4,9,14 These recommendations include a comprehensive assessment of medical and service needs; comprehensive training; and timely and thorough communication of information to the child, family, and the accepting care providers. 4,6,8,9,14,[19][20][21] Although children requiring postacute care are a vulnerable population, no evidence-based management guidelines exist for transitioning to and from post-acute care. The identifi cation of current practice is a critical fi rst step in this process.…”