LAUSR

BACKGROUND Scheduling timely outpatient follow-up appointments is part of a high-quality discharge process. In many centers, residents and hospitalists schedule follow-up appointments, often without patient input due to time constraints. METHODS A needs assessment was conducted to quantify clinician time spent making discharge appointments and to identify barriers to successful appointment scheduling. A four-week pilot intervention subsequently embedded a discharge scheduler responsible for scheduling discharge appointments into five house staff teams. The goals of the pilot were to incorporate patients' scheduling preferences when making appointments, to improve appointment attendance, and to reduce administrative burden on residents. Results were analyzed using chi-square and Fisher's exact tests. RESULTS Patients expressed a strong preference to be involved in scheduling follow-up appointments. In the intervention, there was a statistically significant increase in successfully scheduled appointments (66.7% vs. 87.7%; p < 0.0001) and attendance at follow-up appointments (43.9% baseline vs. 62.9% intervention; p = 0.011), a statistically significant reduction in rescheduled appointments (16.7% baseline vs. 4.9% intervention; p = 0.008), a nonsignificant trend toward increased number of canceled appointments (7.6% baseline vs. 17.5% intervention; p = 0.088), and no significant difference in no-show rates (18.2% baseline vs. 14.7% intervention; p = 0.544). Of residents involved in the pilot, 100% reported that the scheduler improved their ability to care for patients. CONCLUSION This pilot suggests that adding a nonclinical team member tasked with scheduling discharge appointments improved alignment of the discharge process with patients' preferences and may be of value to residents, hospitalists, and the health care system.