A Systematic Approach to Patient Transition
Haris Ahmed, MD, Katie Mueller, NP, Elizabeth Pelle, MA, Lena Riley, RN, Therese Byrne, RN, Vicky Hellmann, RN, James Woodrum, MBA, Pramod Reddy, MD, Brian Vanderbrink, MD, Andrew Strine, MD.
Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.
BACKGROUND: Transitioning care as complex pediatric patients reach adulthood can be a difficult endeavor for patients' and families as well as providers. The goal of transition is to establish the patient in an adult healthcare environment where care is optimized for the adult patient. We sought to improve our ability to transition patients smoothly by implementing a systematic process developed by our quality improvement collaborative. METHODS: A baseline transition rate was established by retrospectively reviewing complex patients 16 years and older over a 15 week period from January 2018 to April 2018. Our primary goal was defined as a provider having initiated a discussion regarding transition in patients between 16 and 21 years old. For patients >21 years old and without contraindication to transitioning a secondary goal was determining whether or not an appointment had been made with an adult provider. A 90% success rate in transitioning patients was defined as our goal outcome. Key drivers to be addressed for planned interventions were identified as buy-in from patients and families, buy-in from providers, identifying adult providers who were able and willing to provide appropriate care to patients, and creating a means of transmitting pertinent medical records to adult providers. Based on these key drivers interventions were developed and implemented. Changes in our rate of transitioning patients were tracked on a weekly basis from April 2018 through October 2018. RESULTS: Our patients ranged in age from 16 to 47 years old with a median age of 20 years. Our baseline transition rate was determined to be 40%. Early interventions were aimed primarily at informing the providers of the Transition of care initiative, and at reminding providers which patients merited a discussion regarding transition at the time of their visit. Later interventions focused on improving provider and patient participation. These included reminder emails for the providers, and a pamphlet outlining the transition process for patients and families. A system by which routing a patient chart to a particular staff member would automatically initiate the process of making an appointment with an adult provider and transmitting pertinent medical records was also established. Transition rate at the end of data collection had increased to 70%. Of 33 patients >21 years of age, 17 had appointments scheduled with adult urology providers. CONCLUSIONS: In creating a systematic process to address transition of care, we were able to identify specific obstacles to transitioning and create targeted interventions to overcome those obstacles. This has allowed for a measurable increase in our rate of successful transition.
Back to 2019 Abstracts