Incorporating the Voice of Community Based Pediatricians to Improve Discharge Communication

• Authors: Lindsay Weiss, Emory University; Anthony Cooley, Emory University; Evan Orenstein, Emory University; Matthew Levy, Emory University; Mary Edmond, Children’s Healthcare of Atlanta; Emily Wong, Children’s Healthcare of Atlanta; Hannah Hua, Children’s Healthcare of Atlanta; Nicole Hames, Emory University
• Journal Title: Pediatric Quality and Safety
• Volume: Volume 5, Number 4
• Publisher: Lippincott, Williams & Wilkins | 2020-07-10
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1097/pq9.0000000000000332
• Subjects: Health Sciences, Health Care Management
• Keywords: pediatric hospitalists; primary care physicians; discharge; transition; Communication

Abstract

Introduction: Communication between pediatric hospitalists and primary care physicians (PCPs) at discharge is an essential part of a successful transition to home. While many hospitals require communicating with PCPs for all admitted patients, it is unknown if PCPs find such communication valuable or if it improves outcomes. Our global aim was to improve discharge communication for patients that pediatric hospitalists and PCPs deemed appropriate. Methods: We sent surveys to 422 outpatient pediatricians in our care network to understand their communication preferences. Survey results informed local guidelines for when hospitalists should directly contact PCPs. We determined the proportion of inpatient discharges meeting those guidelines and set a target for our primary process metric: the proportion of discharges with attempted direct PCP contact. We engaged in Plan-Do-Study-Act cycles, including a discharge documentation tool in the electronic health record, education of inpatient teams, email reminders including group performance data, asynchronous Health Insurance Portability and Accountability Act-compliant messaging application, and competitions that shared blinded individual data. Results: We increased the percentage of documented direct communication with the PCPs from 2% to 33% and from 4% to 65% for those who met guidelines for direct communication. Conclusions: PCPs only want direct communication on a subset of discharges. Interventions focused on high-yield populations improved discharge communication in our institution.