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Abstract
Background Timely post-discharge follow-up ensures safe inpatient/outpatient care transitions. Minimizing messaging to facilitate transitions is critical to staff well-being.
Objectives Improve the proportion of outpatient dermatology appointment scheduled within 2 weeks post-discharge to >90%; decrease staff messaging facilitating scheduling by >25%.
Methods Through process mapping dermatology care transitions (figure 1) we identified barriers to timely scheduling. We assessed impact of two interventions on post-discharge scheduling: video visits (VVs) initiated (March 2020) in response to COVID-19 and SmartPhrase intervention initiated (April 2021) in response to perceived high staff messaging rates (figure 2). We tracked time from discharge to scheduling of post-discharge appointment, percentage of patients scheduled ≤2 weeks, and staff messaging from Jan 2019 through May 2021. Satisfaction was evaluated via stakeholder interviews.
Results Post-discharge VVs increased from 0% to 64% following adoption of telemedicine. The average number of days to schedule these improved from 31 days without VVs to 11 days with VVs; additional adoption of the SmartPhrase further reduced it to 6 days (figure 3). The percent of patients scheduled within 2 weeks improved from 79% without VVs to 82% with VVs, and then to 90% with SmartPhrase adoption (figure 4). Compared to scheduling rates prior to implementation of both interventions, the combination of VVs and SmartPhrase saved 72 discharged dermatology patients approximately 1824 days of wait-time in post-discharge appointment scheduling. Messaging has not yet decreased significantly, but longer follow-up is needed to assess whether messaging rates changed post-SmartPhrase implementation (figure 5). Early qualitative findings suggest overall satisfaction with VVs and the SmartPhrase workflow.
Process map of inpatient to outpatient dermatology care transitions for discharged patients requiring outpatient follow-up (developed by inpatient faculty, residents, new patient coordinators, front office staff, and nursing staff involved in scheduling) [NOTE. *For new patients only, IP team includes the inpatient dermatology team; IP=inpatient; OP=outpatient; NPCs=new patient coordinators]
SmartPhrase used by the inpatient dermatology team as part of a new workflow to help facilitate timely scheduling
Impact of video visits and SmartPhrases on scheduling of post-discharge appointment
Impact of video visits and SmartPhrases on percent of patients scheduled for post-discharge appointment within 2 weeks
Impact of video visits and SmartPhrases on number of scheduling messages sent by three stakeholders (administrative/support staff, inpatient faculty and residents)
Conclusions Early data suggest decreased time to post-discharge scheduling and increased percentage scheduled within two weeks post-VV implementation, and further improvement post-SmartPhrases. Staff messages did not decrease significantly; we plan to track messaging rates through August to fully assess SmartPhrase impact.