P0597 - Inpatient Strategies to Reduce Transportation Barriers Lead to Improved Attendance at Post-Hospitalization Appointments: An Interprofessional Quality Improvement Project

Introduction: Multiple factors for non-attendance at post-hospitalization appointments (PHA) have been identified in the literature (1). Transportation barriers have been associated with lower socioeconomic status, elevated levels of stress, and poorer general health (2,3). In 2017, while examining our pediatric hospital to home transition metrics, we discovered our patients missed 38% of their scheduled PHA, some due to transportation barriers. This inpatient quality improvement project aimed to increase inpatient assessment of transportation barriers for families and improve attendance at the first PHA.


Methods: In July 2018, an interprofessional team of nurses, physicians, and care coordinators, on a 30-bed inpatient pediatric unit started to meet monthly, to generate Plan-Do-Study-Act cycles, trial tests of change, review process control charts, and implement practice changes. Staff were educated about the significance of transportation barriers, assessment, and electronic health record (EHR) documentation. A list of local transportation resources was created, discharge instruction smart phrases for transportation resources were created, and primary care providers were notified of families with transportation barriers. Collaborating with outpatient providers, we audited PHA attendance.


Results: By December 2019, our process measure, EHR documentation of transportation assessment, increased from 1% to 94% (Figure 1). More families with transportation barriers were identified (1.2% to 5.2%). Our outcome measure, attendance at first PHA, improved for all patients (62% to 82%) and for those with transportation insecurity (0% to 57%) (Figure 2). Our balance measure, percent of discharges by 2PM, did not change during this period.


Discussion: Emphasizing the importance of attendance at the first PHA to patients and caregivers lead to an increase in PHA attendance rates. Educating care managers, nurses, and physicians about the significance of transportation insecurity and helping families access available resources was another step to improving PHA attendance for patients with transportation insecurity. Our next steps include identifying other issues that may affect attendance at pediatric PHA.