Improving Outpatient Provider Communication for High-Risk Discharges From the Hospitalist Service.

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Pediatric Hospital Medicine

Background:

• Inpatient-to-outpatient care transitions pose risks for adverse events.
• Gaps persist in discharge communication despite previous improvement efforts.
• Effective communication between hospitalists and PCPs is crucial for high-risk pediatric discharges.

Purpose of the Study:

• To increase documentation of 2-way communication between hospitalists and PCPs for high-risk pediatric discharges.
• To improve the quality and reliability of care transitions for vulnerable pediatric patients.
• To achieve a target of 60% documentation of 2-way communication within 30 months.

Main Methods:

• Utilized A3 improvement methodology and a driver diagram to guide interventions.
• Defined high-risk discharge criteria through collaboration with PCPs and hospitalists.
• Monitored outcome (documented 2-way communication), process (communication attempts), and balancing (hospitalist satisfaction) measures using statistical process control charts.

Main Results:

• The outcome measure for documented 2-way communication peaked at 39% but sustained at 27%, falling short of the 60% goal.
• The process measure for communication attempts peaked at 64% but regressed to 41%.
• Hospitalist dissatisfaction with communication expectations increased from 5% to 13%.

Conclusions:

• The improvement methodology yielded modest, partially sustained gains in PCP communication for high-risk pediatric discharges.
• Sustaining significant improvements in discharge communication remains a challenge.
• Interventions included education, feedback, standardization, and task offloading to support staff.