Methods:
Our team conducted a prospective quality improvement project with the
specific intention to evaluate and improve a specific practice or
program, which per institutional guidance was exempt from Institutional
Review Board review. Utilizing an online survey generator, Survey
Monkey®, we sent a link via email for an anonymous survey to 49 internal
medicine residents. The survey consisted of one question identifying the
resident’s year of training, two Likert-scale questions, and four
open-answer questions (Figure 1) to assess baseline resident
satisfaction and workload burden associated with establishing PCP
follow-up at the time of patient discharge from the hospital. Following
the results of the first survey, our team identified factors leading to
dissatisfaction among residents in the discharge planning process
(Figure 2) and created a flow diagram outlining the current process for
establishing PCP follow-up at the time of discharge (Figure 3). Our team
then worked within the confines of our current electronic medical record
(EMR) system to create a standardized, streamlined process for
establishing patient follow-up at the time of discharge. This process
included step-by-step instructions to locate PCP information in the
chart; provide patient with discharge instructions; order follow-up
appointments, labs, and tests; and communicate with PCPs both inside and
outside of our institution’s healthcare network. Our first intervention,
an instructional conference held at resident noon conference, outlined
this new streamlined process. Six weeks after the educational session, a
second, four-question survey was sent to 49 residents, using the same
method as previously outlined. This survey again contained one question
identifying the resident’s year of training, the same two Likert-scale
questions, and one multiple choice question to assess whether the
resident had attended the teaching session. For our second quality
improvement intervention, pocket cards (Figure 4) were distributed to
residents via email and hung on the wall of all inpatient resident work
stations. Following the second intervention, a third, five-question,
anonymous survey was sent to all internal medicine residents. This
survey again contained one question identifying the resident’s year of
training, the same two Likert-scale questions, one multiple choice
question to assess whether the resident had attended the initial
teaching session, and an additional multiple choice question to assess
whether the resident had referenced the instructional pocket cards. Data
from all surveys were compiled using Survey Monkey® software and
exported to excel for statistical analysis. Data analysis was completed
using the Mann Whitney U test.