Improving Safety During Transitions of Care Through the Use of Electronic Referral Loops to Receive and Reconcile Health Information.

Abstract

Medicare's Promoting Interoperability Program evaluates how often organizations completely reconcile differences between the internal medical record with problems, medications, and allergies received from outside electronic health records (EHRs) during hospitalizations. This quality improvement project sought to increase rates of complete reconciliation of patient problems, medications, and allergies to 80% of hospitalizations for 90 consecutive days at all eight hospitals in an academic medical system by December 31, 2021. Baseline characteristics were determined using monthly reconciliation performance from October 2019 to October 2020. The intervention period occurred from November 2020 to December 2021 and consisted of 26 Plan-Do-Study-Act cycles. Performance was monitored from January 2022 to June 2022 to observe the sustainability of the initiative. Statistical process control charts were used to identify special cause variation in system-level performance. All eight hospitals successfully recorded 90 consecutive days of complete reconciliation above 80% in 2021, and seven of eight hospitals maintained this goal in the sustainability period. Average baseline reconciliation was 22.1%. System-level performance satisfied criteria for baseline shift after PDSA 17, when the average performance was recalculated as 52.4%. Criteria for a second baseline shift were satisfied during the sustainability period, when the average performance was recalculated at 79.9%. Overall performance has remained within the recalculated control limits throughout the sustainability period. An intervention that included enhancing EHR workflows, training medical providers, and communicating division performance was successful in increasing and sustaining complete reconciliation of clinical information in a multihospital medical system.