Weiss Lindsay, Cooley Anthony, Orenstein Evan, Levy Matthew, Edmond Mary, Wong Emily, Hua Hannah, Hames Nicole
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
Pediatr Qual Saf. 2020 Jul 10;5(4):e332. doi: 10.1097/pq9.0000000000000332. eCollection 2020 Jul-Aug.
Communication between pediatric hospitalists and primary care physicians (PCPs) at discharge is an essential part of a successful transition to home. While many hospitals require communicating with PCPs for all admitted patients, it is unknown if PCPs find such communication valuable or if it improves outcomes. Our global aim was to improve discharge communication for patients that pediatric hospitalists and PCPs deemed appropriate.
We sent surveys to 422 outpatient pediatricians in our care network to understand their communication preferences. Survey results informed local guidelines for when hospitalists should directly contact PCPs. We determined the proportion of inpatient discharges meeting those guidelines and set a target for our primary process metric: the proportion of discharges with attempted direct PCP contact. We engaged in Plan-Do-Study-Act cycles, including a discharge documentation tool in the electronic health record, education of inpatient teams, email reminders including group performance data, asynchronous Health Insurance Portability and Accountability Act-compliant messaging application, and competitions that shared blinded individual data.
We increased the percentage of documented direct communication with the PCPs from 2% to 33% and from 4% to 65% for those who met guidelines for direct communication.
PCPs only want direct communication on a subset of discharges. Interventions focused on high-yield populations improved discharge communication in our institution.
儿科住院医师与基层医疗医生（PCP）在患者出院时的沟通是顺利过渡到家庭护理的重要环节。虽然许多医院要求针对所有入院患者与PCP进行沟通，但尚不清楚PCP是否认为这种沟通有价值，或者它是否能改善治疗效果。我们的总体目标是改善儿科住院医师和PCP认为合适的患者的出院沟通情况。
我们向我们护理网络中的422名儿科门诊医生发送了调查问卷，以了解他们的沟通偏好。调查结果为制定住院医师应何时直接联系PCP的当地指南提供了依据。我们确定了符合这些指南的住院患者出院比例，并为我们的主要流程指标设定了一个目标：尝试直接与PCP联系的出院患者比例。我们开展了计划-执行-研究-改进循环，包括在电子健康记录中使用出院记录工具、对住院团队进行培训、发送包含团队绩效数据的电子邮件提醒、使用符合《健康保险流通与责任法案》的异步消息应用程序，以及开展分享匿名个人数据的竞赛。
对于符合直接沟通指南的患者，我们将记录在案的与PCP直接沟通的比例从2%提高到了33%，从4%提高到了65%。
PCP只希望在一部分出院病例中进行直接沟通。针对高收益人群的干预措施改善了我们机构的出院沟通情况。
