Optimizing discharge teaching process to increase the efficiency and effectiveness of the follow-up call.

Abstract

226 Background: Patients undergoing complex oncologic operations are at high risk for perioperative complications associated with adverse effects on quality of life, costs and overall outcomes. Complications within 30 days of discharge are most commonly identified during first 48-72 hours post-discharge. Telephone follow-up can provide a safety net and is part of a larger discharge teaching process. Initial review of the current follow up processes underscored many variations. An interdisciplinary team was tasked to optimize discharge processes across the continuum of care which leads to a more efficient follow-up call encounter. Methods: Working with in and outpatient frontline staff from focus group teams, pre and post implementation work flow processes were captured. Inefficiencies were used for a redesign session to develop a standard discharge teaching guide and patient checklist. A database was used for data collection of measures for issues and complications encountered by patients. Storyboards were used to communicate the project progression to those working within the processes being redesigned. Results: A 42% reduction in inefficiencies of overall discharge teaching process was obtained with the largest decrease during the post discharge phase. The number of patients contacted during follow-up calls increased by 12%: discussions were longer and documentation took less time (excluding outliers). 46% of the issues were handled by the Clinical Nurse Leaders: all other medium/high issues were handed off to primary team. The time spent for follow-up calls increased, therefore, increasing direct labor cost. The rate of complications and severity decreased during the implementation phase. Effects on the readmission rates remains to be seen and patient satisfaction scores are showing a positive trend. Conclusions: Involving content experts to assess the discharge teaching process identified a worklist of inefficiencies. Using these to optimize the process, a discharge teaching guide and patient checklist were developed. Inefficiencies were reduced and process made more effective with an increased percent of patients contacted during the follow-up call.