Evolution of a project to improve inpatient-to-outpatient dermatology care transitions: a mixed methods evaluation (Preprint)

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.