JMIR Publications

ABSTRACT

Background:

In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require post-discharge follow-up in outpatient dermatology. Safe and timely care transitions from inpatient to outpatient specialty care are critical for patient health, but communication around these transitions can be disjointed and workflows complex.

Objective:

This 3-phase quality improvement effort developed and evaluated an intervention that leveraged an Electronic Health Record (EHR) feature, known as SmartPhrase, to enable a new workflow to improve transitions from inpatient care to outpatient dermatology.

Methods:

Phase 1 (February-March 2021), included process mapping with key stakeholders to identify gaps and inform an intervention: a SmartPhrase table and associated workflow to promote collection of patient information needed for scheduling follow-up and closed loop communication between dermatology and scheduling teams. In phase 2 (April-May 2021), semi-structured interviews—with dermatologists (n=5), dermatology residents (n=5), schedulers (n=6)—identified pain points and refinements. In Phase 3, the intervention was evaluated by triangulating data from these interviews with measured changes in scheduling efficiency, visit completion, and messaging volume pre- (January-February 2021) and post-implementation (April-May 2021).

Results:

Pre-intervention pain points included: unclear workflow for care transitions, limited patient input in follow-up planning, multiple messaging channels (e.g., EHR-based, email, phone messages), and time-inefficient patient tracking. The intervention addressed most pain points; interviewees reported the intervention was easy to adopt and improved scheduling efficiency, workload, and patient involvement. More visits were completed within the desired timeframe of 14-days post-discharge during post-implementation (45%, n=21) than pre-implementation (68%; n=28; P=.03). Messaging workload also decreased from 88 scheduling-related messages sent for 25 patients pre-implementation, to 30 messages for 8 patients post-implementation.

Conclusions:

Inpatient to outpatient specialty care transitions are complex and involve multiple stakeholders, thus requiring multi-faceted solutions. With deliberate evaluation, broad stakeholder input, and iteration, we designed and implemented a successful solution using a standard EHR feature, SmartPhrase, integrated into a standardized workflow to improve timeliness of post-hospital specialty care and reduce workload.