Mind the Gap: Improving Transitions of Care After Inpatient Endoscopy at an Academic Medical Center

Abstract

Introduction: Follow-up after inpatient endoscopy is suboptimal in patients discharged from the hospital. To evaluate the gap in care, prior review of 182 consecutive inpatients (3-month period) undergoing endoscopy at our academic center found that when repeat endoscopy was recommended, less than 30% of patients completed it. Possible barriers included poor communication between services, lack of scheduling, and poor patient follow-up. We aimed to increase the rate of completion of follow-up endoscopies after discharge. Methods: Electronic reminders were sent from 9-11/2015 to inpatient GI consult teams to include indication for repeat endoscopy in reports, to message the scheduler, and to assure appointments were included on discharge instructions. A flyer was posted in the workroom and a presentation was given to the fellows regarding the gap in care. We then reviewed the records to determine the rate of completion of recommended follow-up endoscopy and clinic visits for patients who underwent inpatient endoscopy during our quality improvement intervention. Results: 210 consecutive inpatient endoscopies were performed in the quarter of the intervention (Table 1). Prior to intervention, repeat endoscopy was indicated in 54/182 patients and recommended for 38/54. Of these, 11 patients completed the repeat study (28.9%). After the intervention, of 65/210 patients for whom repeat endoscopy was indicated, it was recommended in 49 patients. Of these 49 patients, 30 patients completed the recommended repeat procedure (61.2%) (Figure 1). This represents a significant improvement (Chi square p= 0.003). The indications for repeat endoscopy are outlined in figure 2. Before our intervention, 66/90 patients recommended to follow in GI clinic did so. Since intervention, significantly more patients (52/54, fisher's exact p= 0.0003) followed up as recommended.1071_A Figure 1. Pre and Post-Intervention Patient CharacteristicsConclusion: This study supports that a simple quality improvement initiative of reminders and education doubled follow-up endoscopy after hospitalization. While less than 30% completed recommended studies before, over 60% of patients did so afterwards. Furthermore, while only 73% of patients followed up in clinic before, the rate of follow-up post-intervention increased to 96%. Similar systems can be implemented throughout other centers and increase likelihood of both outpatient endoscopy and office visit follow-up and offer our patients optimal transitions of care.1071_B Figure 2. Significant Endoscopic Findings and Follow Up Outcomes Pre and Post Intervention