Dataset Information

Evolution of a Project to Improve Inpatient-to-Outpatient Dermatology Care Transitions: Mixed Methods Evaluation.

ABSTRACT:

Background

In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require postdischarge 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 can be complex.

Objective

In this 3-phase quality improvement effort, we 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 interviews with patients and 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), semistructured interviews-with dermatologists (n=5), dermatology residents (n=5), and 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 preimplementation (January-February 2021) and postimplementation (April-May 2021).

Results

Preintervention pain points included unclear workflow for care transitions, limited patient input in follow-up planning, multiple messaging channels (eg, EHR based, email, and 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 after discharge during the postimplementation period (21/47, 45%) than the preimplementation period (28/41, 68%; P=.03). The messaging workload also decreased from 88 scheduling-related messages sent for 25 patients before implementation to 30 messages for 8 patients after implementation.

Conclusions

Inpatient-to-outpatient specialty care transitions are complex and involve multiple stakeholders, thus requiring multifaceted 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 the timeliness of posthospital specialty care and reduce workload.

SUBMITTER: Kling SMR

PROVIDER: S-EPMC10335331 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Evolution of a Project to Improve Inpatient-to-Outpatient Dermatology Care Transitions: Mixed Methods Evaluation.

Kling Samantha M R SMR Aleshin Maria A MA Saliba-Gustafsson Erika A EA Garvert Donn W DW Brown-Johnson Cati G CG Amano Alexis A Kwong Bernice Y BY Calugar Ana A Shaw Jonathan G JG Ko Justin M JM Winget Marcy M

JMIR dermatology 20230525

<h4>Background</h4>In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require postdischarge 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 can be complex.<h4>Objective</h4>In this 3-phase quality improvement effort, we developed and evaluat ...[more]

PMID: 37632927

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Project description:IntroductionPrimary-secondary school transitions are critical transitions for children that can be emotionally demanding longitudinal experiences, which can positively and negatively impact future emotional wellbeing and mental health. However, interventions that have been developed to reduce the negative outcomes children commonly experience are limited in number, sustainability, and reach and rely on a cross-sectional approach, as opposed to longitudinal evaluations. The current study evaluates Transitions 5-7, a universal, class-based 9-week intervention to develop children's awareness and ability to cope with the multiple changes experienced over primary-secondary school transitions.MethodsThe evaluation utilized a mixed-methods approach, combining both quantitative outcome and qualitative process intervention evaluation. For the outcome evaluation, a quasi-experimental research design was used, and children of the intervention and comparison groups completed a questionnaire in Year 5 (n = 185), Year 6 (n = 217), and Year 7 (n = 162), which assessed their self-reported perception of Transitions Worries, Transitions Excitement, Emotional Wellbeing, Parental Support, and Coping Efficacy. To understand the implementation of Transitions 5-7, three focus groups were conducted with Year 6 children, 3 interviews with teachers, and 1 interview with the Transitions Manager of the local government education authority during the project, who developed Transitions 5-7.ResultsThe outcome evaluation found that children participating in the intervention showed a decrease in Transitions Worries and an increase in Transitions Excitement and Coping Efficacy compared with the comparison group, resulting in a lowered impact on Emotional Wellbeing over time. The need for a more systemic approach to primary-secondary school support provision, which is gradual, has a distinct delivery and follows a skills-based curriculum, was discussed in the process evaluation. Meta-inferences drawn demonstrate the importance of gradual emotional centered transitions provision embedded within Years 5, 6, and 7.DiscussionThe present study makes a unique empirical contribution in demonstrating the need and viability to take a preventative as opposed to a curative approach to primary-secondary school transitions support provision and begin early in Year 5. Conceptual and methodological implications for future research and implications for educational policy and practice are discussed.

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Dataset Information

Evolution of a Project to Improve Inpatient-to-Outpatient Dermatology Care Transitions: Mixed Methods Evaluation.

Background

Objective

Methods

Results

Conclusions

Publications

Evolution of a Project to Improve Inpatient-to-Outpatient Dermatology Care Transitions: Mixed Methods Evaluation.

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