VCU Health

Vimal Mishra

Have you ever been hospitalized? Or at least spent hours within the ED waiting for test results and discharge? The whole experience is anxiety-producing, leaving you spent with exhaustion from disruption to your normal lifestyle.

Then the good news comes that you will be discharged! As a patient, you are thinking, I can’t wait to sleep in my own bed, and have something I like to eat. Depending on the situation, you may also have lots of questions and concerns.

Upon discharge, the nurse inundates you with information, and, as typical human nature prevails, you only really listen to a small percentage of this information. Once you are home, you rely on whatever paperwork you were handed or a family member’s recollection of what you were told. As a result, many of the important discharge instructions often are not followed in a timely manner, or at all. Nearly 20% of Medicare patients are re-hospitalized within 30 days of discharge, and nearly 20% of patients experience adverse events within 3 weeks of discharge, nearly three-quarters of which could have been prevented or ameliorated. Minimizing post-discharge adverse events has become a priority for the US health care system.

" VCU Health created Hospital Medicine and Trauma Surgery post-hospital discharge clinics to reduce patient harm, improve post-discharge safety, quality, enhance patient engagement, care coordination, patient satisfaction related to the discharge process, and adherence to discharge instructions."

VCU Health created Hospital Medicine and Trauma Surgery post-hospital discharge clinics to reduce patient harm, improve post-discharge safety, quality, enhance patient engagement, care coordination, patient satisfaction related to the discharge process, and adherence to discharge instructions. Early results from both clinics have been very encouraging with a very high (4.98/5) rating of online care by patients and more than 66% reduction in no show rate as compared to in-person trauma post-discharge clinic. Additional observations included the identification of an average of more than one discharge issue per patient. Discharge issues were not related to one aspect of care but multifaceted, requiring intervention by the clinical team with support from interdisciplinary team suggesting that single modal intervention like only nurse call or pharmacy intervention probably will not be sufficient to support our patients need and will fall short of expectations. An estimated 20% of patients participating in the virtual encounter may have returned to the ED or sought other care venues. Additionally, most of the issues were resolved within a day with a definitive plan initiated by the care team. Not all these issues could have been anticipated and addressed at the time of discharge.

Developing the communication and workflow to enroll patients in a virtual clinic prior to them leaving the hospital has required proactive data pulls, coordination among providers, clinicians, and support staff, and integration of a script for these visits as part of the discharge discussion.

Two tools have been incorporated to help with the overall approach, one being that all patients are “opted in”, and a hardcopy postcard with details explaining the purpose of the virtual post-discharge is provided to the patient to avoid a failed “cold call” once a patient is back home.