Department of surgery resident helps drive quality improvement initiative
A UF Health systemwide quality improvement initiative aims to simplify discharge instructions that patients receive before they leave the hospital.
The after-visit summary, or AVS, is designed to provide patients with information about their stay or surgical procedure, how to care for themselves after discharge, and who to call if there are questions or problems. The AVS also includes information mandated by the U.S. Centers for Medicare and Medicaid Services, like smoking cessation, heart attack and stroke awareness and suicide prevention.
“Essentially, patients need to know how to care for themselves at home and who to call with questions and concerns,” said Juan Mira, MD, a surgical research resident. “If patients don’t understand the discharge process, there is a higher chance of readmission to the hospital.” Mira was part of a multidisciplinary committee that revised the AVS for surgical and medical patients.
While the previous AVS provided most of the necessary information, follow-up appointments and important phone numbers — like the clinic and hospital contact information — were hard to find. Instructions for self-care were buried in the middle of the document, or at the end of several pages. The medication list was duplicated, and the reason for hospital admission was absent. Additionally, a significant amount of information was either redundant or unnecessary.
Through efforts of the committee, a condensed inpatient AVS template was implemented. In the new template, information and instructions deemed most important by the care team (e.g., reason for admission, specific instructions, phone numbers and medications) are now on the first pages of the AVS.
“By removing redundant information like medication history, we were able to prevent medication errors in some of the cases where the information was not accurate,” Mira said.
The new AVS is available for all discharges. He is currently working with residents from other disciplines to improve instructions for medical patients.
The committee also saw room for improvement in the Department of Surgery’s internal discharge process. Championed by Mira, the department has made several changes. First, a new discharge order set for the department has been created, providing a unified and easy-to-follow process that generates the optimal AVS. Second, more than 30 discharge instruction templates have been created and reviewed for the 11 UF Department of Surgery service lines. These instructions contain up-to-date material that has been approved by the attending surgeons from each division for optimal post-hospitalization care.
Third, resident and extender education regarding the patient discharge process has been provided during a weekly conference and with individual sessions. Additionally, a resident website detailing the discharge process templates has been proposed; it is expected to be built later this year.
Lastly, questions regarding discharge instructions have been added to the existing postop patient survey, which is administered in UF Health Surgical Specialists clinics at UF Health Shands Hospital and at the UF Health Springhill locations. These questions are intended to provide feedback on the patient discharge process experience, focusing particularly on discharge instructions. Ultimately, the department intends to provide these discharge instructions online via the departmental website for patient reference.