Increasing Follow-Up Appointment Completion Rates in Transitions of Care: A Pilot Study
Nature and scope of the project
Noncompletion of follow-up appointment requests is an ongoing problem due to competing staff responsibilities, technology challenges, and inadequate communication during hospital transitions to post-acute care. From January 1, 2019 to March 31, 2019, 58% of follow-up appointments requested by an acute care hospital on discharge were not ordered after transition of care to a skilled nursing facility and 44% of SNF residents were readmitted to acute care within 30 days. The follow-up appointment completion rate was 42%. Barriers associated with poor attendance of follow-up appointments were not documented.
Synthesis and analysis of supporting literature
The National Transitions of Care Coalition defines transitions of care as a set of actions based on a comprehensive care plan that includes treatment goals, preferences, and clinical status to ensure coordination and continuity of care. The accurate transfer and acknowledgment of patient information in transitions of care to ensure continuity and promote successful treatment is essential. One of the strongest predictors for hospital readmission after discharge to a skilled nursing facility is variation in transitional quality care. More than 20% of Medicare beneficiaries discharged from a hospital to SNF result in rehospitalization within 30 days of the initial hospital discharge, costing Medicare more than $4 billion per year.
Project implementation
To implement a follow-up appointment completion protocol to increase follow-up appointment completion rates and identify barriers to decrease hospital readmission rates with the use of a computerized clinical information system.
Evaluation criteria
An attendance log was utilized to evaluate stakeholder agreement and completion of staff training. Data were collected electronically via a password protected Microsoft EXCEL spreadsheet by the project director to evaluate the completion of orders placed for follow-up appointments, chart audits were completed, and the (see Appendix E for Chart Audit Tool). A quantitative data analysis was completed to obtain the percentage of the number of key stakeholders in agreement of interventions, staff attendance to training session, and residents that orders for follow-up appointments were entered into PCC.
To evaluate barriers identified, completion of follow-up appointments, hospital readmissions rates, and chart audits were completed throughout the project implementation and data were collected electronically via a password protected Microsoft EXCEL spreadsheet by the project director (see Appendix E for Chart Audit Tool). Post implementation data were collected biweekly at one month, and then again at one, two, and three months throughout the project implementation. A quantitative data analysis was completed to obtain the percentage of barriers identified, completion of follow-up appointments, and hospital readmission rates.
Outcomes
In July 2020, 100% of key stakeholders approved the follow-up appointment completion protocol and 62% of resident care staff and the appointment scheduler completed training on the protocol. By September 2020, 81% of admitted residents to the short-term care stay unit had orders for follow-up appointments. The follow-up appointment completion rate increased to 46% and the readmission rate decreased by 20% (The t-statistic was not significant, p = 0.809 and p = 0.140, respectively). Barriers were identified as non-scheduled appointments and resident refusal.
Recommendations
It is recommended to implement the follow-up appointment completion protocol to the entire facility and continue the use of the computerized clinical information system to identify barriers to follow-up appointment completion to improve processes and influence outcomes.
Increasing Follow-Up Appointment Completion Rates in Transitions of Care: A Pilot Study