Improved Adherence to Follow-Up Care in the Trauma Patient

Abstract

Problem: Trauma patients discharged from an urban level 1 trauma center are at risk of being lost to follow up care when they are advised to follow up and do not. Interventions around the transition from inpatient to outpatient can positively impact outpatient follow-up rates and decrease readmissions. Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to implement a structured home discharge process that includes scheduling appointments, educating on follow-up appointments, post discharge phone calls, and monitoring of patients who miss their appointments in order to improve adherence to follow-up care in the trauma population. Methods: A structured discharge process that includes the Advanced Practice Providers (APP) requesting an appointment and attaching the updated discharge education, the nurse checking appointments on after-visit summary (AVS) and reviewing clinic discharge education, and the clinic staff contacting patients who did not have a scheduled appointment at discharge or did not complete their scheduled appointment was created and audited throughout the project phase. Results: Appointments scheduled at discharge increased from 28% (n=28) to 62% (n=113), education attached to AVS increased from 86% (n=97) to 92% (n=295), and NRC post discharge phone call answering increased from 38% (n=43) to 46% (n=77). 69 patients where recommended to follow up but did not discharge with an appointment, however, 78% (n=54) were scheduled after discharge. Appointments completion rate was 83% (n=142) post intervention compared to 74% (n=71) pre-intervention. Conclusion: Results show that appointment scheduling, education attached to AVS, answering of NRC post discharge calls, and appointment completion rate all increased with this intervention. There was minimal impact to readmissions, 6% (n=7) at baseline and 7% (n=21) post intervention, as well as lost to follow-up rate, 19% (n=21) at baseline and 18% (n=33) post intervention.