Background: Post-hospitalization follow-up is an important phase of care transitions. However, it continues to be a challenge for patients to keep office visit appointments made at the time of discharge, particularly if the visit is with a primary care physician that is new to the patient. Directly involving patients in the appointment scheduling process may help improve their likelihood of showing up at the follow-up visit.
Purpose: The goal of this project is to improve primary care post-hospitalization appointment attendance by including the patient directly in the follow-up appointment scheduling workflow.
Description: The original workflow for scheduling post-hospitalization follow-up appointments required physicians to call a referral office to set up an appointment. The scheduler would make the first available appointment, in this time frame requested, with the primary care physician (PCP). If the patient did not have a primary care physician, he or she was scheduled with an Internal Medicine resident in the primary care clinic. Upon discharge, the patient would be informed of the day and time of their appointment.
The new workflow starts with placing an electronic order to schedule a post-hospitalization follow-up for the patient. The order goes to a real-time work queue and a representative from the referral office is immediately notified. The representative then physically goes to the patient’s room and schedules an appointment with direct participation from the patient who is then able to pick the time and day that will work best. The designation of the patient’s primary care physician is also confirmed at this time. This new workflow was initially piloted on a single teaching service unit staffed by upper level Internal Medicine residents who were supervised by hospitalists.
Since the implementation of the workflow change, a total of 157 discharge appointments were scheduled on the pilot service, 80 (51%) utilized the new workflow. With the new workflow, the proportion of appointments made with a PCP outside the hospital-affiliated medical group increased significantly, from 16.9% to 37.5% (p=0.004). Of appointments scheduled with hospital-affiliated PCPs, the attendance rate went up, from 35.9% to 56.9% (p=0.025).
Conclusions: Engaging patients in the discharge appointment scheduling workflow significantly improved the chance that the appointment is made with their own PCPs and that they will show up for the appointment. Expansion of the workflow change to the rest of the hospital will hopefully help validate these findings and determine the sustainability of the intervention on a larger scale.