Improving Outpatient Provider Communication for High-Risk Discharges From the Hospitalist Service.

BACKGROUND: Patients are at risk for adverse events during inpatient-to-outpatient transitions of care. Previous improvement work has been targeted at this care transition, but gaps in discharge communication still exist. We aimed to increase documentation of 2-way communication between hospitalists and primary care providers (PCPs) for high-risk discharges from pediatric hospital medicine (PHM) services from 7% to 60% within 30 months. METHODS: A3 improvement methodology was used. A list of high-risk discharge communication criteria was developed through engagement of PCPs and hospitalists. A driver diagram guided interventions. The outcome measure was documentation of successful 2-way communication with the PCP. Any documented 2-way discharge communication attempt was the process measure. Via a survey, hospitalist satisfaction with the discharge communication expectation served as the balancing measure. All patients discharged from PHM services meeting ≥1 high-risk criterion were included. Statistical process control charts were used to assess changes over time. RESULTS: There were 3241 high-risk discharges (442 baseline: November 2017 to January 2018; 2799 intervention and sustain: February 2018 to June 2020). The outcome measure displayed iterative special cause variation from a mean baseline of 7% to peak of 39% but regressed and was sustained at 27%. The process measure displayed iterative special cause variation from a 13% baseline mean to a 64% peak, with regression to 41%. The balancing measure worsened from baseline of 5% dissatisfaction to 13%. Interventions temporally related to special cause improvements were education, division-level performance feedback, standardization of documentation, and offloading the task of communication coordination from hospitalists to support staff. CONCLUSIONS: Improvement methodology resulted in modestly sustained improvements in PCP communication for high-risk discharges from the PHM services.

Pathways to Publication in Pediatric Hospital Medicine Educational Research.

OBJECTIVES: Dissemination of rigorous, innovative educational research is key to inform best practices among the global medical education community. Although abstract presentation at professional conferences is often the first step, journal publication maximizes impact. The current state of pediatric hospital medicine (PHM) educational scholarship dissemination via journal publication has not been well described. To describe educational research dissemination after PHM conference abstract submission, we identified the publication rate, median time to publication, and median publishing journal impact factor of abstracts submitted over 4 years. METHODS: Abstract data were obtained from the 2014-2017 PHM conferences and organized by presentation type (oral, poster, rejected). PubMed, MedEdPORTAL, and Google Scholar were queried for abstract publication evidence. We used logistic regression models, Kaplan-Meier survival curves and Kruskal-Wallis tests to determine the association of presentation type with the odds of publication, time to publication, and publishing journal impact factors. RESULTS: Of 173 submitted educational research abstracts, 56 (32%) were published. Oral abstracts had threefold greater and fivefold greater odds of publication compared to poster and rejected abstracts, respectively (odds ratio 3.2; 95% confidence interval 1.3-8.0; P = .011; odds ratio 5.2; 95% confidence interval 1.6-16.7; P = .003). Median time to publication did not differ between presentation types. The median journal impact factor was >2 times higher for published oral and poster abstracts than published rejected abstracts. CONCLUSIONS: Because abstract acceptance and presentation type may be early indicators of publication success, abstract submission to the PHM conference is a reasonable first step in disseminating educational scholarship.