title: Improving the reliability of verbal communication between primary care physicians and pediatric hospitalists at hospital discharge.
abstract: BACKGROUND
  Timely and reliable verbal communication between hospitalists and primary care physicians (PCPs) is critical for prevention of medical adverse events but difficult in practice. Our aim was to increase the proportion of completed verbal handoffs from on-call residents or attendings to PCPs within 24 hours of patient discharge from a hospital medicine service to ≥90% within 18 months.
  
  
  METHODS
  A multidisciplinary team collaborated to redesign the process by which PCPs were contacted following patient discharge. Interventions focused on the key drivers of obtaining stakeholder buy-in, standardization of the communication process, including assigning primary responsibility for discharge communication to a single resident on each team and batching calls during times of maximum resident availability, reliable automated process initiation through leveraging the electronic health record (EHR), and transparency of data. A run chart assessed the impact of interventions over time.
  
  
  RESULTS
  The percentage of calls initiated within 24 hours of discharge improved from 52% to 97%, and the percentage of calls completed improved to 93%. Results were sustained for 18 months. Standardization of the communication process through hospital telephone operators, use of the discharge order to ensure initiation of discharge communication, and batching of phone calls were associated with improvements in our measures.
  
  
  CONCLUSIONS
  Reliable verbal discharge communication can be achieved through the use of a standardized discharge communication process coupled with the EHR.
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Grant M
authors.initials: GM
authors.lastname: Mussman
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Vossmeyer
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.|James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Brady
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Warrick
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.|James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Simmons
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Christine M
authors.initials: CM
authors.lastname: White
mesh_terms: D002648:Child; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards; D057286:Electronic Health Records / Q000592:standards; D020445:Hospitalists; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D010351:Patient Discharge / Q000592:standards*; D010372:Pediatrics; D058007:Physicians, Primary Care; D011787:Quality of Health Care; D015203:Reproducibility of Results