Chinese Hospital incorporates follow up appointments in official discharge instructions to help patients and their doctors take them seriously.
We conducted root cause analyses on our readmissions and realized a big cause of readmissions was that patients weren’t going to follow up appointments after discharge. Some of the reasons for this were that patients didn’t understand the importance of a follow up appointment, they tried to schedule one but the doctor’s schedule was booked, or sometimes doctors didn’t think it was necessary to see patients within the first week of discharge.
Chinese Hospital is a non-profit hospital in San Francisco, CA. It has 54 beds and serves a primarily elderly (average age of 76) monolingual population with most patients speaking only Chinese. Their transitions program began in 2008 and is influenced by IHI’s Transforming care at the Bedside and the Care Transitions Program.
What We Tried
We tried two different things to get patients in to see doctors within a week of discharge. The team shares the data and work with the medical staff about the importance of the earlier post discharge follow up appointment. We also provide education to nursing staff on this issue. Then our doctors write the follow up appointment into the discharge instructions, specifying that it should happen within the first week. That way, both the patients and their primary care providers realize the importance of the appointment.
We also coached patients on how to make their appointments. Rather than just ask for a regular checkup, we tell them to say “I was just discharged from the hospital and the discharge instructions say that I need to see a doctor within the first week of going home.” That way, the doctors’ offices understand that it’s an urgent appointment.
More of our patients have been getting follow up appointments with these two approaches, but there’s still more we can do. We’re working closer with our outpatient clinics now, using them as a backup when patients can’t get appointments with their primary care providers.
We try not to make appointments for patients because we want to encourage self-care, but in some cases we will try calling doctors directly.