Improving elderly patient care coordination by focusing on outpatient providers' needs
TimeFriday, April 1611:40am - 12:00pm EDT
LocationPatient Safety Research and Initiatives
DescriptionPROBLEM STATEMENT: Obtaining accurate clinical information about recent acute care visits is extremely important to the outpatient providers who treat patients after they have been discharged. However, the documents used to communicate this information vary in content, organization, and format, and they are often difficult to use. This puts patients at risk of adverse events due to ineffective information transfer. Elderly patients, who tend to be seen by more providers and to have more care transitions, are especially vulnerable.
OBJECTIVE: Our long-term goal is standardizing discharge summaries so that the clinical information in these documents is organized in the same way regardless of where a patient receives acute care. The objective of this initial study was eliciting outpatient providers’ preferences for structuring the data needed to coordinate care for elderly patients.
METHODOLOGY: Eleven physicians who treat elderly patients (aged 65 or more years) were asked to perform an open card sorting task during individual interviews. Each of 36 index cards contained the label for a data field which had previously been identified as either useful, or necessary, in elderly patient discharge summaries (e.g. discharge date, diagnoses, follow-up appointments, Tremoulet & Shah, 2020). The card sorting data was analyzed by creating an item-by-item matrix (Righi, James et al 2013), constructing a dendogram, and identifying themes in participant comments. The item-by-item matrix and dendogram representations were used to create initial groups and subgroups, and the themes were used to create initial headings and sub-headings for those groupings.
RESULTS: We used both intuitive, exploratory analysis and numerical analysis to identify patterns in participants' groupings, and based upon that analysis, we created two different possible templates for creating standardized elderly patient discharge summaries that reflect different ways of organizing and grouping the same set of information.
Next steps include collaborating with an outpatient provider to populate those templates with realistic, fictitious patient data and then conducting a survey of outpatient providers to get feedback on the two different sample discharge summaries and their recommendations for modifying their structure and/or layout. Once we have collected responses from those surveys, we can help to define requirements for creating standardized discharge summaries that will make it easier for outpatient providers to coordinate care for their patients. This will help increase patient safety and could also help to address provider burnout.