Increasing Follow-Up Appointment Completion Rates in Transitions of Care

Abstract

Purpose of Study: Noncompletion of follow-up appointment requests is an ongoing problem due to competing staff responsibilities, technology challenges, and inadequate communication during hospital transitions to post-acute care. From 1 January 2019 to 31 March 2019, 58% of follow-up appointments requested by an acute care hospital on discharge were not ordered after transition of care to a skilled nursing facility (SNF) and 44% of SNF residents were readmitted to acute care within 30 days. The follow-up appointment completion rate was 42%. Barriers associated with poor attendance of follow-up appointments were not documented. The purpose of the study is to implement a follow-up appointment completion protocol to increase follow-up appointment completion rates and identify barriers to decrease hospital readmission rates with the use of a computerized clinical information system. Primary Practice Setting: A 232-bed for-profit, corporate-owned SNF in the west suburb of Chicago that offers a variety of services in addition to skilled nursing care including short-term rehabilitation, physical therapy, and long-term care. Methodology and Sample: An attendance log was utilized to evaluate stakeholder agreement and completion of staff training. Data were collected electronically via a password-protected Microsoft Excel spreadsheet by the project director to evaluate the completion of orders placed for follow-up appointments and chart audits were completed. A quantitative data analysis was completed to obtain the percentage of the number of key stakeholders in agreement of interventions, staff attendance to training sessions, and residents whose orders for follow-up appointments were entered into PointClickCare (PCC). To evaluate the barriers identified, completion of follow-up appointments, hospital readmission rates, and chart audits were completed throughout the project implementation and data were collected electronically via a password-protected Microsoft Excel spreadsheet by the project director. Post implementation data were collected biweekly for 1 month, and then again for 1, 2, and 3 months throughout the project implementation. A quantitative data analysis was completed to obtain the percentage of barriers identified, completion of follow-up appointments, and hospital readmission rates. Results: 81% of admitted residents to the short-term care stay unit had orders for follow-up appointments. The follow-up appointment completion rate increased to 46% and the readmission rate decreased by 20%. Barriers were identified as non-scheduled appointments and resident refusal. Implications for Case Management Practice: Implementing a follow-up appointment protocol can significantly enhance the quality of patient care and operational efficiency. Regular follow-up appointments allow health care professionals to assess progress, manage medications, detect complications early, and provide necessary guidance and interventions for optimal outcomes. A follow-up appointment protocol can help streamline transitions between levels of care, ensuring patients receive timely and appropriate services.