At our medical center, there are 14,716 discharges annually from the general medicine services. Post discharge appointments are made by residents, nurse practitioners, and hospitalists. In a baseline survey, clinicians identified logistical barriers to successfully making appointments and revealed that patients are rarely involved in scheduling discharge appointments. Only an estimated 66% of attempted appointments were scheduled by the time of patient discharge.
We designed a pilot to embed a discharge scheduler into general medicine teams. The objectives of the pilot were to reduce administrative burden on clinical staff, incorporate patients’ needs and preferences for discharge appointments, and improve patient attendance at post-discharge appointments
Baseline data were collected in a time-motion study and clinician survey. Based on these data, a temporary employee was hired for four weeks to make discharge appointments. This scheduler worked with a total of four resident-led medical teams, each with a census of 20-24 patients. Overall, the scheduler attempted to make 163 appointments for 118 patients, averaging 1.38 appointments per patient.
Each morning, the scheduler met with resident team leaders, then visited each patient and offered assistance in making appointments. Patients could choose to have the scheduler book the appointment from the patient’s room, have the scheduler book the appointment on his own and inform the patient of the appointment date and time, or patients could choose to make the appointment themselves. The scheduler documented the number of appointments made, patient preferences, and then tracked whether the patient went to the appointment. We also surveyed residents on the impact of this pilot on their workflow.
Of the 163 appointments attempted by the scheduler, 89% of appointments were successfully made at the time of discharge. For 85/163 (55%) of appointments, patients preferred that the scheduler make the appointment with them in the room and 54/163 (34%) wanted to make their own appointments. Only 15/163 (9%) requested the appointment be made without their input. Based on preliminary data, the percentage of completed appointments rose from 31% during the time-motion study to 58% during the intervention period. Clinic no-show rates also decreased in the groups that either made their own appointment (9%) or had their appointment made with the scheduler in the room (10%) compared to the time-motion study (17%). Resident team leaders stated that the scheduler improved their ability to establish follow-up appointments and care for patients (9/9, 100%); 8/9 (89%) stated that the scheduler saved them time (up to 45 minutes per day).
The existing discharge process demands valuable clinician time and is not patient-centered despite patients’ overwhelming preference to be involved in making their own appointments. Therefore as patients prepare to return to their daily lives, we should engage them in discharge appointment scheduling and recognize the need to partner with patients in order to achieve better outpatient appointments attendance. In this pilot, an embedded discharge scheduler was able to involve patients in discharge planning at the bedside, elicit preferences, and improve the percentage of successfully scheduled appointments and actual follow up while reducing clinicians’ administrative burden.