Transitions from one care setting to another are a persistent quality gap across the province, one that can negatively impact both patient outcomes and system costs when a lack of appropriate follow-up results in worsening health and hospital readmissions. Data shows that follow-up with primary care within 7 days of discharge contributes to readmission avoidance.
St. Thomas Elgin General Hospital (STEGH) consistently experienced higher than expected readmission rates, and with the help of the IDEAS program, the changes they implemented resulted in a nearly 50% decrease in readmissions and cost avoidance of $325,000.
St. Thomas Elgin General Hospital (STEGH) consistently experienced higher than expected readmission rates (~20% actual, compared to ~16% expected). When they looked at the data, they saw that the overall percentage of patients attending a follow-up appointment with a primary care physician within seven days of discharge from hospital was lower than the provincial average.
What’s more, only 41% of discharge summaries were sent from the hospital to the community primary care provider within 48 hours—so when patients did have a follow-up appointment, physicians were often unaware because they had not received a discharge summary.
This was clearly problematic, and STEGH turned to IDEAS to learn the skills that would enable them to improve.
The change ideas included:
1. Having physicians dictate their discharge summaries within 48 hours of discharge. A scorecard was developed to track percentage of dictations done within 48 hours by the physicians (anonymously) and posted in the physician office. Transcription was outsourced (which was planned prior to the IDEAS project) and an auto send process was initiated to eliminate the authentication process that was contributing to a delay in sending.
2. Having ward clerks schedule follow up appointments with patients' family doctor at time of discharge (goal: within 7 days of discharge). Data from Health Quality Ontario showed that follow up with primary care within 7 days of discharge contributes to readmission avoidance. Multiple cycles were tested to determine how to best identify patients in the selected CMG category. In order to capture 100% of that population and reduce the time it takes to search for information, we determined that 100% of patients discharged (except those to long-term care or another inpatient facility) will receive an appointment.
View the full project summary here.
Below is a summary of the results that STEGH was able to achieve. This indicator is now an organizational accountability, including in STEGH’s annual Quality Improvement Plan and their Leadership Scorecard.
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