Improving Direct Admissions to Internal Medicine Services.

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Medical Informatics

Background:

• Direct hospital admissions from clinics or homes can enhance efficiency and reduce emergency department (ED) utilization.
• However, suboptimal direct admission processes may elevate the risk of patient harm during care transitions.
• Multidisciplinary teams are essential for understanding and optimizing these admission pathways.

Purpose of the Study:

• To understand and improve the process of direct admissions to inpatient medicine services at a major academic medical center.
• To identify and address critical communication gaps within the direct admission workflow.
• To implement a standardized intervention to mitigate risks associated with care transitions.

Main Methods:

• A single-institution quality improvement initiative was conducted.
• Key communication gaps in the direct admission process were identified.
• A handoff tool, comprising a templated note and order set, was implemented to bridge identified communication gaps.

Main Results:

• The intervention was launched in April 2022, with sustained utilization of the handoff tool.
• A peak utilization rate of 24% for the handoff tool was observed in January 2023.
• Feedback-driven improvements included adding direct admission instructions and refining the handoff note content.

Conclusions:

• This study successfully designed and implemented a quality improvement initiative focused on direct adult medicine patient admissions.
• The initiative effectively identified and addressed communication gaps within the direct admission process.
• The findings highlight the importance of standardized tools in improving patient safety during care transitions.