Berger Rebecca E, Yang Shaun, Weiner Jonathan, Gace Denisa, Finn Kathleen
Jt Comm J Qual Patient Saf. 2019 Aug;45(8):580-585. doi: 10.1016/j.jcjq.2019.05.007. Epub 2019 Jul 4.
Scheduling timely outpatient follow-up appointments is part of a high-quality discharge process. In many centers, residents and hospitalists schedule follow-up appointments, often without patient input due to time constraints.
A needs assessment was conducted to quantify clinician time spent making discharge appointments and to identify barriers to successful appointment scheduling. A four-week pilot intervention subsequently embedded a discharge scheduler responsible for scheduling discharge appointments into five house staff teams. The goals of the pilot were to incorporate patients' scheduling preferences when making appointments, to improve appointment attendance, and to reduce administrative burden on residents. Results were analyzed using chi-square and Fisher's exact tests.
Patients expressed a strong preference to be involved in scheduling follow-up appointments. In the intervention, there was a statistically significant increase in successfully scheduled appointments (66.7% vs. 87.7%; p < 0.0001) and attendance at follow-up appointments (43.9% baseline vs. 62.9% intervention; p = 0.011), a statistically significant reduction in rescheduled appointments (16.7% baseline vs. 4.9% intervention; p = 0.008), a nonsignificant trend toward increased number of canceled appointments (7.6% baseline vs. 17.5% intervention; p = 0.088), and no significant difference in no-show rates (18.2% baseline vs. 14.7% intervention; p = 0.544). Of residents involved in the pilot, 100% reported that the scheduler improved their ability to care for patients.
This pilot suggests that adding a nonclinical team member tasked with scheduling discharge appointments improved alignment of the discharge process with patients' preferences and may be of value to residents, hospitalists, and the health care system.
安排及时的门诊随访预约是高质量出院流程的一部分。在许多中心，住院医师和医院医生负责安排随访预约，由于时间限制，通常没有患者的参与。
进行了一项需求评估，以量化临床医生安排出院预约所花费的时间，并确定成功安排预约的障碍。随后进行了为期四周的试点干预，将一名负责安排出院预约的出院调度员纳入五个住院医师团队。试点的目标是在预约时纳入患者的预约偏好，提高预约出席率，并减轻住院医师的行政负担。使用卡方检验和费舍尔精确检验分析结果。
患者强烈希望参与安排随访预约。在干预组中，成功安排的预约有统计学显著增加（66.7%对87.7%；p<0.0001），随访预约的出席率也有统计学显著提高（基线时为43.9%，干预后为62.9%；p=0.011），重新安排的预约有统计学显著减少（基线时为16.7%，干预后为4.9%；p=0.008），取消预约的数量有增加的非显著趋势（基线时为7.6%，干预后为17.5%；p=0.088），未到诊率没有显著差异（基线时为18.2%，干预后为14.7%；p=0.544）。参与试点的住院医师中，100%报告称调度员提高了他们照顾患者的能力。
该试点表明，增加一名负责安排出院预约的非临床团队成员可改善出院流程与患者偏好的一致性，对住院医师、医院医生和医疗保健系统可能有价值。
