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Promoting High-Value Practice by Standardizing Communication between the Hospitalist and Primary Care Provider during Hospitalization

From the 2019 HVPAA National Conference

Dr. Marwa Moussa (NYU Langone Health), Dr. Carrie Mahowald (NYU), Dr. Himali Weerahandi (NYU Langone Health), Dr. Charles Okamura (NYU Langone Health)

Background

The increasing complexity of admitted patients, shorter hospital stays and post-acute care adverse events demand a more sophisticated and effective coordination of care between hospitalists and Primary care providers (PCPs). A review of our institution’s 30 day readmissions between 1/2018-4/2018 found that 19% were attributed to lack of PCP/outpatient provider follow-up. Surveys of our community PCPs showed 70% reported being contacted by the hospitalist group in less than 25% of the time.

Objectives

This is a project that targets academic hospitalists and Primary Care Providers (PCP) in our community.

1. Standardizing communication between Hospitalists and PCPs during hospitalization will lower the rate of readmission attributed to lack of PCP follow up and post-acute care adverse events.

2. Implementing this practice into our daily workflow will improve PCP satisfaction and increase referrals to our institution.

Methods

We reviewed a root-cause survey of 30 day readmissions between 1/2018-4/2018 as well as readmission rates for each of our hospitalists. We surveyed our PCPs’ satisfaction with communication experiences with our hospitalist group. Finally, we conducted a semi-structured interview of the hospitalist with the lowest readmission (8% vs 12% average for other hospitalists) and highest PCP satisfaction rates, Dr. A, to develop best practices for closed loop communication. Based on this data, we designed a protocol and piloted on 5/1/2018, where the hospitalist contacts the PCP via phone call on admission and delivers a discharge narrative to the PCP via our EMR’s routing capability. We used a trackable smart phrase to document the communication.

Follow up satisfaction surveys will be sent to the PCPs 6 months after our revised communication practice. Finally, we will monitor the hospitalists’ compliance with the smart phrase.

Results

A qualitative analysis of the interview with Dr. A revealed that after her encounter with the patient, she calls the patient’s PCP highlighting the admitting diagnosis, significant events, pertinent labs, imaging and medications. Dr.A then delivers a discharge narrative to the PCP on the day of discharge highlighting any medication changes, incidental findings and follow up.

On a random audit of 100 charts between 5/1/2018-10/30/2018 our preliminary data show that there was 88% compliance with using the smart phrase by the hospitalists.

Prior to our intervention our 30-day readmission rate for the general medicine service during the month of 4/2018 was 14.6%. Post intervention we saw a steady downtrend during the months of 5/2018, 6/2018 and 7/2018 of 14.1%, 12.7 % and 11.5%, respectively.

Conclusions

Implementing a standardized approach for Hospitalist-PCP communication demonstrated a trend towards improving readmission rates post intervention.

Clinical Implications

Using a “positive deviance” approach, we identified best practices for hospitalist-PCP closed loop communication to develop an intervention to improve this aspect of care. If we maintain success in reducing readmission rates and improvement in PCP satisfaction, we will expand to other services to implement this program as best practice.

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