Evaluating the Impact of Reduced Inpatient Provider Discontinuity on Patient Outcomes: Readmissions, Satisfaction and Length of Stay
Keywords:continuity of patient care
patient length of stay
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Publisher:The Ohio State University
Series/Report no.:The Ohio State University. College of Nursing Doctor of Nursing Practice Final Document Projects
BACKGROUND: Continuity of care has inevitably been associated with improved patient outcomes. However, the percentage of hospitalized patients receiving care from one primary provider declined from 70.7% in 1996 to 59.4% in 2006 (Fletcher et al., 2011). The resulting fragmentation in care has been associated with reduced patient outcomes (decreased satisfaction, increased length of stay, hospital mortality, post discharge mortality and increased readmissions. OBJECTIVE: The objective of this quality improvement project was to improve patient outcomes (length of stay, patient satisfaction and 30- day unplanned readmission rates) by decreasing the scheduling discontinuity of Inpatient Medical Oncology Advanced Practice Providers (APP). DESIGN: A continuity-based scheduling model was developed based on the department's average length of stay and the Inpatient Medical Oncology Advanced Practice Providers' surveyed scheduling preferences. The piloted scheduling model reduced the fragmentation in care for Inpatient Medical Oncology Advanced Practice Providers by 30%. RESULTS: After two months of piloting the new continuity-based schedule, the comparison of pre and post-implementation patient satisfaction rates and length of stay index scores did not favor the continuity based scheduling model. In addition, the comparison of pre and post-implementation unplanned 30-day readmission rates was inconclusive. CONCLUSION: This project established that Inpatient Medical Oncology Advanced Practice Providers prefer a continuous-based scheduling model. However, further analysis is needed to determine the clinical impact that an APP continuity-based scheduling model has on patient outcomes.
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