Rosemarie Kauffman BSN RN CMSRN – SH Nursing Administration
Scheduling post-discharge follow-up appointments is critical, but not easy
for patients and providers. Research has shown that scheduling follow-up
appointments before a patient is discharged with input and engagement
from patients and caregivers is one of the most critical elements to a
safe and effective transition. Our organization has adopted this as best practice, but most of our patients
continue to leave the hospital without confirmed appointments and many
providers remain frustrated by a highly manual and unreliable system.
I call this the “discharge follow-up appointment challenge”.
I identified the need to adopt and implement a quality improvement project
to improve compliance with scheduling follow-up appointment as a way to
contain health care costs and improve patient care. The Centers for Medicare
and Medicaid Services (CMS) has also proposed that patients receive specific
follow-up appointments when discharged from hospitals to prevent costly
This project involves Quality, Safety, Service, and Finance Pillars of MWHC.
With the help of my Preceptee, we collected data to support the need for
this project. I also presented in-services, posted huddle messages and
posters to educate the staff on the Inpatient Units at SH starting July 20, 2015.
N = 66 (number of patients who had follow-up appointments made before discharge)
D = 162 (number of patients who did not have follow-appointment made)
After implementation and education to the staff:
N = 33 (number of patients who had follow-up appointments made before discharge)
D = 66 (number of patients who did not have follow-appointment made)
Based on my findings, this will be an on-going process because compliance
with scheduling follow-up appointment is still very low.
The following actions will be taken for improvement:
- continue to educate the staff about the follow-up appointment process
- get the support from management to assign a dedicated HUC/CNA at least
on day shift who will manage the front desk
- continue to partner with the hospital volunteers
- empower the patients and caregivers to be part of the transition process
and help them understand the importance of follow-up
- work with physician practices/providers when requesting appointments to
give the patients being discharged from the hospital a priority
- explore computer systems/web-based applications or IT-enabled scheduling
processes for follow-up appointments that can be shared across the health
system as well as community providers (at least start with the members
of the Mary Washington Alliance)
- Compliance with scheduling Follow-up Appointments before the patients are
discharged has increased to 75% (from 8/23/15 – 11/20/15). Data
was gathered from the Inpatient Units (ICU, 2WSU, 3WES, 4WCU)
- The increase in compliance was attributed to having a dedicated HUC/CNA
on the 3WES unit from Monday – Friday on Day Shift. There is also
a part-time HUC/CNA on the 4WCU who assumed the role later.