Background: Post-discharge follow-up appointments (PDFA) are an important component of care transitions. Many hospital medicine groups dedicate substantial time arranging these visits. In a one year retrospective analysis of patients discharged from our hospitalist service, the attendance rate for PDFA was only 46% and the no-show/same-day cancel (NS/SDC) rate was 36%. Detailed phone interviews of a subset of patients that had NS/SDC revealed that many had forgotten about the appointment and that lack of transportation was a barrier to their attendance.

Purpose: To improve attendance rates at post-discharge follow-up appointments for patients discharged from a hospitalist service.

Description: We designed a quality improvement intervention to improve PDFA attendance on one hospital medicine unit at a teaching hospital. The intervention occurred at the time of discharge and included the discharge nurse 1) providing each patient with a calendar printed on colored paper that had the PDFA noted on it, 2) reminding patients to input PDFAs into their smart phone calendars if they had one, and 3) offering enrollment in a text message reminder program to patients who had at least one PDFA scheduled with an affiliated outpatient practice. The text program included a message sent to the patient and their support person, if designated, seven days prior to their PDFA reminding them of the date and time of the appointment. Patients received a second message requesting that they reply to the text message to confirm the appointment, indicate the need for help with rescheduling or transportation, or to request to speak with a representative. Hospitalist administrative staff contacted patients who requested help with rescheduling, transportation, or had a question. Staff rescheduled appointments and arranged cab rides to and from PDFAs, which were paid for through our hospital medicine group. Patients were offered the QI intervention beginning in July 2016. During the first 3 months of the program 319 patients (66% of all patients discharged during this same time period) were provided with intervention 1 and 2 as described above, 141 were eligible and agreed to participate in the text message program, and 90 of the enrolled patients have received text messages and had their PDFA. Only 3 patients requested assistance with rescheduling and 6 requested help with transportation. Attendance at PDFA and readmission rates are being tracked for all patients enrolled in the program. Attendance rates at PDFA increased to 61% (from 46% at baseline) and the NS/SDC rate decreased to 30% (from 36% at baseline).

Conclusions: Placing more focus on PDFA at the time of hospital discharge coupled with an interactive text message led to improved attendance rates at post-discharge follow-up appointments. Further time and automation will be needed to determine if the early results seen from this intervention are sustainable and should be scaled to include more patients.