PC1242: A Quality Improvement Project to Improve Hospital-to-home Transitions of Care Using Discharge Tele-visits

Purpose/Objectives: One in five families report a major problem with the transition from hospital-to-home. Virtual telephone visits (tele-visits), which are gaining popularity during the COVID-19 pandemic to improve healthcare access, cost, experience, and effectiveness, can potentially enhance the safety of hospital-to-home transitions.
Starting October 2020, conduct hospital discharge televisits to improve follow up within 72 hours of hospital discharge from 35% to 50% and completed follow up from 70% to 85% by August 2021.

Design/Methods: A team of pediatric residents, hospitalists, outpatient pediatricians and quality improvement specialists convened starting in July 2020 and used the Model for Improvement and key driver diagram to guide improvement work (Figure 1). Baseline data was collected from June 2020-October 2020. From October 29, 2020, to August 31, 2021, the team conducted the following Plan-Do-Study-Act cycles: Built a televisit template in the electronic medical record with 10 slots per week, trained residents on televisit workflow, created a previsit checklist, and provided feedback to and elicited feedback from providers conducting the televisits. The outcome measures were the proportion of patients with televisits who had follow up within 72 hours of discharge and with completed follow up. The process measure was the proportion of tele-visit appointment slots filled. The balancing measure was seven-day readmissions. Topics addressed during the tele-visits were also recorded and categorized. Data was tracked continuously and displayed on run charts

Results: There were 308 televisits scheduled and 275 (89.3%) completed during the study period. Follow up within 72 hours increased to 71.2% (Figure 2a) and completed follow up to 90.7% (Figure 2b). Topics addressed included results of diagnostic testing, medication issues, scheduling subspecialty appointments and symptom-related concerns (Figure 3). Of the 434 available televisit slots, 308 (71.0%) were scheduled. There were 4 (1.5%) readmissions within 7-days of discharge for patients with completed televisits.

Conclusion/Discussion: Televisits are an innovative way to increase timeliness and completeness of hospital discharge follow up. Since they are conducted by the inpatient physician team who discharged the patient, they provide superior continuity of care compared to traditional follow up and allow for immediate intervention as needed. They also provide opportunities to discuss clinically important topics such as results of diagnostic testing.