31 Reducing variability in discharge communication reduces administrative burden

Abstract

Background Streamlined discharge communication in transitions of care improvement models improve patient satisfaction, improve patient self-efficacy, and reduce readmissions. Yet, significant variability and quality exists in the After Visit Summary (AVS) which is used to guide the post-discharge needs of the patient. Objectives We sought assess the feasibility, fidelity, acceptability, and effectiveness of a standardized, patient-centered AVS. Methods Our multiprofessional and multidisciplinary stakeholder team was led by two physicians and had significant institutional support. We employed a tailored, hybrid implementation strategy, blending components from Lean methodology, the Institute for Healthcare Model for Improvement, and the Consolidated Framework for Implementation Research. We assessed the feasibility (e.g. quality of AVS, usability of template), fidelity (e.g. template utilization rates), acceptability (e.g. direct stakeholder feedback, paging-system audit, patient call logs), and effectiveness (e.g. 30-day readmission rates and patient-centeredness) of our intervention (e.g. standardized, patient-centered AVS). Results Our AVS template was written at a third grade reading level but retained all clinically-relevant information. Providers and patients approved of the template with 66% mean utilization (range 41% to 80%). After our intervention, we observed decreased 30-day readmissions (19.7% to 16.0%). Notably, after the introduction of AVS template, pages sent decreased by 3.67 pages weekly (95% CI=[−15.7, 14.0]), but this estimate was imprecise. Conclusions Reducing variability and improving the quality of discharge communication, not only improves patient outcomes, but may also improve workflow for providers. These improved team dynamics are important to assess when considering an intervention that is operationalized by time and resource deprived employees.