Background: Communication related to medications is an important metric on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to measure patient experience after discharge from the hospital. There are many factors which can lead to poor communication about medications (Figure 1). Over 20% of readmissions can be related to medications, and of these, 50-60% may potentially be preventable. In November 2015, our institution launched a centralized Clinical Advice Service (CAS) to provide seamless connectivity to patients and improve outcomes during transitions of care (ToC). Since May 2016, one of the core functions of CAS has been to make discharge phone calls 24-48 hours after discharge from the hospital. The initial call is made by a patient administrative specialist. The call is escalated to a co-located registered nurse (RN) if any clinical needs are determined. Patients are asked a set of 9 standard questions regarding their discharge instructions, appointments, prescriptions, red flag symptoms, pain control, medical equipment/home health services, and provider contact information. Standard work is utilized to resolve any unmet needs.

Purpose: The purpose of our innovation is to create a centralized approach to review medications with the patient/caregiver post-discharge, answer any questions, offer education about these medications, and resolve medication discrepancies on the after-visit summary in collaboration with the discharging service and the outpatient clinic providers.

Description: In September 2021, CAS began offering and encouraging a comprehensive medication review with a CAS RN to all patients within 24-48 hours of discharge from our hospital. Between September and November 2021, 6,820 patients were offered medication review. Of these 4,484 patients agreed to review their medications with a CAS RN. Of the 4,484 patients, 729 (16%) had a medication-related question or concern. 14.9% of the patients requested clarification on the indication, dose, frequency, adverse effects, drug interactions, or discrepancy between home medications and newly prescribed medications. 1.2% of the patients requested a medication refill. Several of these calls were escalated to the discharging physician by the CAS RN with communication to the outpatient provider. With 6.0 FTE CAS RN per day dedicated for these calls, the patient satisfaction has remained over 95% and it is likely due to the many adverse events or medical errors that were prevented.

Conclusions: Discharge instructions for medications can be overwhelming for patients/caregivers. Offering a centralized approach to support and educated the patients/caregivers during ToC and coordinate with the discharging providers and the outpatient clinic providers can be a viable solution.

IMAGE 1: Figure 1. Factors leading to questions and concerns about medications after hospital discharge