title: Improving transitions of care at hospital discharge--implications for pediatric hospitalists and primary care providers.
abstract: Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high.
authors.affiliation: Medical Affairs, IPC-The Hospitalist Company, North Hollywood, CA, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Harlan
authors.forename: Flory L
authors.initials: FL
authors.lastname: Nkoy
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.forename: Gena
authors.initials: G
authors.lastname: Lattin
authors.forename: Doug
authors.initials: D
authors.lastname: Wolfe
authors.forename: Michael B
authors.initials: MB
authors.lastname: Mundorff
authors.forename: Dayvalena
authors.initials: D
authors.lastname: Colling
authors.forename: Angelika
authors.initials: A
authors.lastname: Valdez
authors.forename: Shay
authors.initials: S
authors.lastname: Lange
authors.forename: Sterling D
authors.initials: SD
authors.lastname: Atkinson
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cook
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maloney
mesh_terms: D002648:Child; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D020445:Hospitalists; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007400:Interprofessional Relations; D010351:Patient Discharge / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011446:Prospective Studies; D014589:Utah