Background: Critical to any health system’s mission is ensuring patients receive timely access to care. Continuity of care has been shown to decrease rates of ED utilization and hospitalizations and to improve patient satisfaction [1]. Providing patients with quick access to care following a hospital stay is a tenet of high-quality health care. A growing concern had arisen within the institution’s Hospital Medicine group about whether discharged patients were receiving follow-up appointments and how quickly. The institution switched to EPIC electronic health record in December 2021, after which multiple methods of requesting follow-up appointments were used. These included messages to schedulers and orders in a discharge workflow. It was often unclear what mechanism to use to obtain follow-up appointments for patients. A team was created to help analyze the hospital discharge follow-up appointment request process and develop a tool to help providers obtain follow-up for patients.
Purpose: The aims of this initiative: – Gain understanding of the process for requesting and scheduling follow-up appointments. – Determine the average amount of time needed for patients to obtain specialty clinic follow up. – Determine best practices for providers requesting appointments and standardize these into a decision tool.
Description: To gain understanding of how long patients were waiting to receive a specialty clinic-follow up appointment, chart audits were conducted. Patients discharged from the two primary units of the Hospitalist service in June and July of 2023 were included. Members of the team reviewed each discharge summary, discharge order set, and after visit summary to determine if a specialty clinic appointment had been requested via an ambulatory referral order. If ambulatory referral orders had been placed, further notation was made as to what clinic was requested, what timeframe was requested, when the appointment was scheduled, whether the patient may have had social determinants of health challenges, and other notes on the patient deemed pertinent to the reviewers. Encounters without ambulatory referral orders were excluded. The time to follow up for each visit was averaged. Concurrent to this review, the team reached out to schedulers to help gain insight into their process once they receive ambulatory referrals and/or messages requesting follow up within the electronic health record. The team also asked about what information schedulers need to obtain timely follow-up. These insights were recorded. Following data collection, the group met to discuss the findings. A job aid was created. In total, 106 patient encounters were reviewed, of which 33 had referrals to a specialty clinic within the health system. These were included in analysis. There was an average wait time of 45.7 days to clinic follow-up. Follow up times ranged between 1 to 185 days. In interviews with schedulers, it was discovered that barriers commonly faced in their ability to schedule a patient were a lack of diagnosis associated with the request and unclear timeline for when they should be seen. They also reported it being helpful for providers to specify the person they should be seen by and to submit requests for follow up early within the hospital stay.
Conclusions: The initiative showed that it is feasible to create a job aid for providers to standardize appointment request workflow. Going forward, it will be important to obtain data to determine if the tool assists in expediting appointments.
