Pharmacist implementation of a transitions of care electronic referral process to provide hand-off between inpatient and outpatient settings.

OBJECTIVE

To describe the implementation of an electronic transitions of care referral process within a large, academic medical center.

PRACTICE SETTING AND DESCRIPTION

To improve communication between the inpatient and ambulatory care pharmacists, the pharmacy department created an electronic referral (e-referral) order, which becomes part of the patient's electronic medical record. Data were collected to describe use of the electronic order and to discuss the role of the referrals in supporting a newly developed ambulatory care pharmacy service.

PRACTICE INNOVATION

The e-referral was built to enhance the efficiency of direct patient care and prioritize patient care activities. This electronic order was built to collect specific details focused on medication-related concerns and provide hand-off to ambulatory care pharmacists for outpatient follow-up.

EVALUATION

A retrospective, cohort analysis of patients was conducted from August 1, 2014, to July 31, 2015. Patients were included in the project if they were 18 years of age or older and received an e-referral order upon transition from the inpatient to the outpatient setting. Patients were excluded if the e-referral was sent from an outpatient setting or if they were younger than 18 years of age. Data were collected to describe the e-referral process and discuss how these referrals supported a new outpatient pulmonary clinic.

RESULTS

A total of 268 inpatient referral orders were included for analysis. Common indications for the referrals included education (49%), follow-up from inpatient consult (46%), adherence (45%), and therapy optimization (42%). A total of 241 (90%) e-referrals were sent from an inpatient pharmacist to an ambulatory care pharmacist; the other 27 (10%) referrals were sent by a physician or mid-level provider. Of the 241 pharmacist referrals, 46 (19%) were placed by pharmacy residents. The majority of inpatient e-referrals (63.4%) were for chronic obstructive pulmonary disease and sent to the outpatient pulmonary clinical pharmacist for follow-up after discharge. The pulmonary clinic ambulatory care pharmacist completed 110 discharge calls (95.7%).

CONCLUSION

An e-referral from inpatient to ambulatory care pharmacists provides pharmacist-to-pharmacist hand-off for medication-related needs after discharge.