Background: Communication between inpatient (IPP) and outpatient providers (OPP) at discharge is essential for continuity of care. However, studies show that communication is often inconsistent, leading to interruptions in care and patient safety events, especially for patients requiring complex management. The discharge summary (DS) serves as the primary mode of communication between IPP and OPP, but survey of local OPP admitting to our large university affiliated, free-standing children’s hospital indicated that this document was lacking clear instructions for OPP management following discharge.
Purpose: Improve OPP post-discharge instruction clarity and completeness within hospital DS for children with medical complexity (CMC) by 50% within 12 months.
Description: Improvement team was formed which included a variety of IPP and OPP. Baseline satisfaction and performance measures were obtained via chart review and survey of providers of CMC treated and discharged between 03/01/2019 to 11/21/2019. CMC were defined by the COE4CCN consensus definition for children with medical complexity. Key interventions to improve clarity of DS information and instructions for OPP were implemented. These included modifications of the DS format sent to OPP, education of residents about the importance of the inclusion of relevant information in the DS, creation of a DS EHR tool (dot phrase: Table) to highlight OPP key information and instructions, and education of attending physicians about the EHR tool. Ongoing education for residents working on the complex care unit was performed each month. Interventions resulted in an increase in the inclusion of clear provider instructions in the DS from 33.3% to 75.6% (Figure) which exceeded our goal. Pre and post OPP surveys showed an increase in the perception of clear provider instructions from 38% to 71%.
Conclusions: Clear communication is essential for transition of care of CMC between IPP and OPP. Modification of the DS format and introduction of an EHR tool were key interventions in improving inclusion of clear OPP instructions. OPP perceptions of improvement mirrored chart review findings. However, given frequent changes in discharging providers of CMC, frequent reeducation regarding dot phrase use was required. Further interventions are needed to embed this change in the system.
