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.