GME Patient Safety Quality and Innovation Symposium

Issues Addressed/Background: Hospital readmissions are a significant problem in the healthcare industry, contributing to increased costs, decreased quality-of-care, and patient dissatisfaction. One potential solution to reduce readmissions is to improve the post-discharge process, including the use of after visit summaries (AVS) to help patients understand and follow their care plans. However, traditional inpatient AVS documents are often lengthy, confusing and lack patient-centered design, leading to poor patient comprehension and adherence. In response, our team undertook a redesign of the inpatient AVS to create a more effective and patient-friendly tool.In our current state, the inpatient AVS document contains unclear discharge instructions, misinformation, outdated information, conflicting information, duplicate information, and information that is simply too difficult for many patients to understand. Additionally, there is seemingly no prioritization for order-of-information, verbiage used is often not patient-friendly, and limited languages are available. At the same time, there is currently an increased burden on providers with a manual discharge instruction process.

Description of the Project: There is an opportunity to revise and reformat the inpatient AVS to better meet our patients’ needs. Epic has features which could be used to streamline content and workflow, but these are not in use at this time. In addition, the lack of a clear governance structure has allowed the information that gets included on an AVS to proliferate. The aim of this project is to optimize the content and creation process of the UCSDH inpatient AVS, ultimately to improve patient quality-of-care and prevent readmissions.UCSDH and its Transformation Health Team sponsored a Kaizen event for this project as a result of goals set forth by the larger readmissions 3P event conducted. The project teams have begun streamlining the existing AVS content while being mindful of patient-friendly language and translation to Spanish of static content. In addition, the teams have been working towards transitioning AVS creation to an orders-based process for providers with increased standardization of content and structure. We are currently rolling out a pilot orders-based AVS on the Women and Infants Unit.

Lessons Learned or Expected Outcomes: Through our redesign of the inpatient AVS, we are learning important lessons. First, we found that patient involvement in the design process is crucial to creating a tool that is truly patient-centered and effective. Secondly, we are learning and expecting that simplifying the language and formatting of the AVS can significantly improve patient comprehension and adherence to care plans. Finally, we are expecting that transitioning to an orders-based discharge instruction workflow forproviders will streamline their processes and increase efficiency, while decreasing outdated and redundant information in the document.

Recommendations/Next Steps: Based on our updated processes, we recommend redesigning the inpatient AVS to decrease readmission rates, increase patient satisfaction and cost-savings for the hospital. This project has the potential to inform and improve post-discharge care processes in hospitals nationwide. Though limited to the inpatient AVS at this time, the scope of the project remains quite large, and we anticipate ample requests for service-line specific content that will require time and effort to coordinate and build. Ultimately, we need to provide a document that gives clear and concise instruction on post-visit care, which is accessible and understandable for all patients and caregivers.