Getting Patients to Clinic: Project to Increase Follow-up after Hospitalization

Introduction: Hospital discharge follow up appointments are critical in making the care transition from the inpatient to the outpatient setting. However, the number of patients who are discharged from our hospital with follow up appointment(s) is low, partly due to the difficulty of navigating the healthcare system. This responsibility often falls on the housestaff, which is an onerous administrative burden. Our resident-led quality improvement (QI) project had three aims: (1) to increase the percentage of discharged patients who left with at least one follow up appointment by 50%, (2) to decrease the time that residents spent obtaining appointments by 50%, and (3) to discharge patients from the hospital earlier by improving the discharge appointment process. Methods: We implemented a clinic phone directory in the inpatient medicine team rooms, with direct line numbers for various subspecialty clinics, in order to reduce residents’ phone times. Our project utilized the IHI Model for Improvement with various plan-do-study-act (PDSA) cycles. We started with 1 inpatient resident medicine team, and expanded our project to include all inpatient resident medicine teams in a step-wise fashion. Our primary measure was the percentage of patients leaving the hospital with at least one discharge appointment in place. Secondary measures included the time of discharge, the amount of time spent on the phone making follow up appointments, and resident satisfaction with the directory. Results: The percentage of patients who left the hospital with at least one follow up appointment in place increased from 28.5% (baseline) to 35.9% (PDSA cycle 3), with a maximum of 48.2% during PDSA cycle 2. The average time of discharge did not change significantly. The average phone time decreased from 18.5 minutes (baseline) to 9.7 minutes (PDSA cycle 3), with a low of 6 minutes during PDSA cycle 2. Residents who used the phone directories found them to be helpful in obtaining follow up appointments. Conclusion: We improved the discharge appointment process by creating a phone directory. This decreased the time spent making follow up appointments and increased the percentage of patients who left the hospital with at least one follow up appointment in place. Leaving with scheduled follow-up aided in the transition of care upon discharge. However, patient discharge times did not change, likely because the actual time of discharge is dependent on several other variables which are independent from discharge follow-up appointments