Destino Lauren A, Dixit Amy, Pantaleoni Julie L, Wood Matthew S, Pageler Natalie M, Kim Joe, Platchek Terry S
Jt Comm J Qual Patient Saf. 2017 Feb;43(2):80-88. doi: 10.1016/j.jcjq.2016.11.005. Epub 2016 Nov 14.
Communication with primary care physicians (PCPs) at the time of a patient's hospital discharge is important to safely transition care to home. The goal of this quality improvement initiative was to increase discharge communication to PCPs at an academic children's hospital.
A multidisciplinary team at Lucile Packard Children's Hospital Stanford used Lean A3 problem solving methodology to address the problem of inadequate discharge communication with PCPs. Emphasis was placed on frontline provider (resident physicians) involvement in the improvement process, creating standards, and error proofing. Root cause analysis identified several key drivers of the problem, and successive countermeasures were implemented beginning in August 2013 aimed at achieving the target of 80% attempted verbal communication within seven days before or after (usually 24-48 hours) on the pediatric medical services. Run charts were generated tracking the outcome of PCP communication.
On the pediatric medical services, the goal of 80% communication was met and sustained during a seven-month period starting October 2013, a statistically significant improvement. In the eight months prior to October 2013, hospitalwide PCP communication prior to discharge averaged 59.1% (n = 5,397) and improved to 76.7% (n = 4,870) in the seven months after (p <0.001). Fifteen of 19 specialty services had a significant increase in discharge communication after October 2013.
Lean improvement methodology (including structured problem solving using A3 thinking), intensive frontline provider involvement, and process-oriented electronic health record work flow redesign led to increased verbal PCP communication at around the time of a patient's discharge.
患者出院时与初级保健医生（PCP）进行沟通对于安全地将护理过渡到家庭至关重要。这项质量改进计划的目标是增加一家学术儿童医院向初级保健医生的出院沟通。
斯坦福大学露西尔·帕卡德儿童医院的一个多学科团队使用精益A3问题解决方法来解决与初级保健医生出院沟通不足的问题。重点是让一线医疗服务人员（住院医师）参与改进过程、制定标准并防止出错。根本原因分析确定了该问题的几个关键驱动因素，并于2013年8月开始实施一系列对策，目标是在儿科医疗服务中，在出院前或出院后七天内（通常为24 - 48小时）实现80%的尝试性口头沟通。生成了运行图以跟踪与初级保健医生沟通的结果。
在儿科医疗服务中，从2013年10月开始的七个月期间实现并维持了80%的沟通目标，这是具有统计学意义的改进。在2013年10月之前的八个月里，全院出院前与初级保健医生的沟通平均为59.1%（n = 5397），在之后的七个月里提高到了76.7%（n = 4870）（p < 0.001）。2013年10月之后，19个专科服务中有15个在出院沟通方面有显著增加。
精益改进方法（包括使用A3思维进行结构化问题解决）、一线医疗服务人员的积极参与以及以流程为导向的电子健康记录工作流程重新设计，使得患者出院前后与初级保健医生的口头沟通增加。
