An Initiative to Improve Performance on a National Transition of Care Measure and to Reduce Readmissions in an Academic Psychiatric Hospital.

Abstract

Inpatient psychiatry discharge planning through careful transition documentation may reduce adverse patient outcomes and decrease hospital readmissions. In 2017 a national psychiatry reporting program instituted a quality metric called the Transition Record with Specified Elements Received by Discharged Patients (TR-1). At Yale New Haven Psychiatric Hospital, the TR-1 metric had 0% provider compliance when the quality metric was instituted. The primary goal of this quality improvement project was to increase the TR-1 metric compliance through use of a structured clinical decision support (CDS) tool and, by extension, reduce the readmission rate. This was a quality improvement project conducted in a 118-bed psych hospital from August 1, 2017, to July 31, 2020, and the preintervention period was from January 1 to July 31, 2017. Demographic and clinical diagnosis data were collected pre- and postintervention. A CDS tool composed of 11 discharge elements was developed and implemented. Primary measures were monthly TR-1 compliance rate as a process metric, and 30-day all-cause readmission rate as an outcome metric. The TR-1 compliance rate increased after CDS tool implementation, with a process mean of 48% in year 1, 56% in year 2, and 65% in year 3. The readmission rate was 9.6% for August 2017 to July 2018, 9.9% for August 2018 to July 2019, and 10.3% for August 2019 to July 2020. A slight upward trend in readmissions was observed over the course of the study, but this was not significant (p = 0.95). We found that implementing a CDS tool improved care transition documentation, which was sustained over time. However, the change was not associated with a decrease in 30-day readmission.