Improving Documentation of Postdischarge Issue Mitigation during Postdischarge Phone Calls

Abstract

Postdischarge phone calls (PDPCs) are recommended to identify and mitigate postdischarge issues such as missed follow-up appointments, medication errors, and failure to activate contingency plans. A current state assessment showed variability in documenting PDPC content and postdischarge issue mitigation. Therefore, the primary aim was to improve the postdischarge issue mitigation documentation rate from 65% to 100% over 16 months.

Methods: An interdisciplinary quality improvement team used the Model for Improvement to perform planned sequential interventions over 16 months. The outcome measure was documentation of postdischarge issue mitigation. Process measures included PDPC template use and completion and postdischarge issue identification. Balancing measures included call attempts and caller perceptions of ease of documentation. Interventions included creating a flowsheet note template, creating caller template training sessions, and sharing team data and feedback. We gathered data via reports generated from the electronic medical record, chart review, and survey. Data were analyzed using statistical process control charts and established rules for detecting special cause variation.

Results: The postdischarge issue mitigation documentation increased from 65% to 91% over 16 months. Template use and completion increased from 0% to 100% and 98%, respectively. The number of postdischarge issues identified remained unchanged. Call attempts increased from 40% to 59%. Caller perceptions remained unchanged.

Conclusions: Documentation of postdischarge issues and issue mitigation promotes adequate communication with the patient's care providers, improving the quality and safety of care. Data sharing to promote team engagement was the key factor in improving documentation of postdischarge issue mitigation.

Fig. 1.

Key driver diagram for improving the rate of documentation of postdischarge issue mitigation.

Fig. 2.

PDPC Questions (in bold), with answer options after the questions. Callers could pick more than 1 option for question 4. Asterisks denote free-text functionality.

Fig. 3.

EHR pop-up flowsheet and PDPC note template. Once fields were selected (left) and the flowsheet pop-up was completed, nurse callers would click the refresh button (highlighted in red above left) to autopopulate the components of the pop-up flowsheet into the note template. Anonymous electronic survey given to callers (in bold), with answer options after the questions. A baseline survey was given before template implementation and then quarterly for 9 months following template implementation.

Fig. 4.

Anonymous electronic survey given to callers (in bold), with answer options after the questions. A baseline survey was given before template implementation and then quarterly for 9 months following template implementation.

Fig. 5.

Statistical process control chart demonstrating percent of charts with documentation of postdischarge issue mitigation by month. UCL not shown when calculated more than 100%. UCL, lower control limit. (Mean shifted using the rule of having 8 or more consecutive points above the CL.) *The outlier noted during the baseline period was removed.

Fig. 6.

Statistical process control chart demonstrating percent of phone call attempts by month. (Mean shifted using the rule of having 8 or more consecutive points above the CL).