Standardization of the Discharge Process for Inpatient Hematology and Oncology Using Plan-Do-Study-Act Methodology Improves Follow-Up and Patient Hand-Off.

Abstract

Hematology and oncology patients represent a complex population that requires timely follow-up to prevent clinical decompensation and delays in treatment. Previous reports have demonstrated that follow-up within 14 days is associated with decreased 30-day readmissions, and the magnitude of this effect is greater for higher-risk patients. This project was designed to standardize the discharge process with the primary goal of reducing average time to hematology and oncology follow-up to < 14 days. Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team of hematology and oncology staff developed and implemented a standardized discharge process. Rotating resident physicians were trained through online and in-person education. Additional interventions included the development of a discharge checklist handout, and a clinical decision support tool including a note template and embedded order set. All patients discharged during the 2-month period before and after the implementation of the standardized process were evaluated. Follow-up appointment scheduling data and communication between inpatient and outpatient providers were reviewed. A total of 142 consecutive patients were reviewed. The primary endpoint of time to hematology and oncology follow-up appointment improved from a mean 17 days prior to intervention to 13 days in PDSA cycles 1 and 2 and 10 days in PDSA cycle 3. The target of 14-day average time to follow-up was achieved. Furthermore, the upper control limit decreased from 58 days at baseline to 21 days in PDSA cycle 3, demonstrating a decrease in variation. Electronic alerting of outpatient hematology and oncology providers to discharge summary increased from 20% before the intervention to 62% after the intervention (P = .01). This quality initiative to standardize the discharge process for the hematology and oncology service decreased time to hematology and oncology follow-up appointments, improved communication between inpatient and outpatient teams, and decreased process variation. Timelier follow-up for this complex patient population will prevent clinical decompensation and delays in treatment.