Care Transitions: Vanderbilt Discharge Follow-Up Appointment Model

Securing a timely follow-up appointment with a patient prior to discharge decreases the rate of patient readmission to the hospital. ^{1 2 3} As access teams rely on evidence-based research to create best practices aimed at enhancing patient access to care, it is important for leaders to identify the interventions that prove successful and why. The Patient Access Collaborative spoke with two access leaders who shared their model for increasing the success rate of follow-up appointments for post-discharge care.

Jennifer DeBruler, MD, VP Patient Access Adult Ambulatory Enterprise and Vanessa Marlowe, Senior Director, Patient Access Services, Vanderbilt University, discussed the initiatives in a two-year pilot study: Vanderbilt Discharge Follow-Up Appointment Model. DeBruler noted, “the primary focus for the Ambulatory Care Department is specifically getting the patient the appointment.” History demonstrates that when a patient leaves the hospital, the task of tracking down the patient and securing a follow-up appointment is extremely difficult.

Vanderbilt utilizes a centralized call center that receives around 3 million calls per year. To facilitate a more successful scheduling outcome, the mostly remote team at Vanderbilt created a specialized, in-hospital staff position. The decision to embed an on-site scheduler in the hospital proved to be a key strategy to achieve success and helped secure appointments with the patients prior to discharge.

DeBruler discussed, “the model in the pilot program focuses on the importance of having a scheduler in the hospital, to meet with the patient and before the patient is discharged. The overarching goal is to maximize the number of appointments and reduce readmission to the hospital.” Research supports two periods which reduce the rate of hospital readmission: a 7-day follow-up and a 14-day follow-up for specialties. If schedulers can secure appointments within these two windows, the chance of readmission diminishes. DeBruler emphasized patient feedback reinforces the need for follow-up appointments and stated, “97% of patients appreciated having a follow-up appointment secured before they left the hospital.”

Although the notion of scheduling a follow-up visit within a specific timeframe seems simple, the team suggested the task is not. Focused on “how” and “what” was needed for outcomes to support better, post-discharge care, DeBruler conveyed, “the goal was how to actually schedule within this window of time, while making sure patients could get into a specialty schedule and be seen in a timely way.”

Dedicated to reaching template capacity, the team at Vanderbilt recognized the “what,” involved introducing an additional step necessary to secure post follow up appointments and creating accurate and timely scheduling. DeBruler stated, “we implemented training for the physicians and the nurses taking care of the patients in the hospital and created an order for the patient to be seen within the post-discharge follow up timeframes. These measures would help ensure the patient was seen at the right time, with the right clinician based on the orders created.”

Much of the success at Vanderbilt is attributed to the on-site scheduler, as well as to providing continuous feedback to the team, confirming the orders have been placed, and maintaining access to the schedules. Here, each component drives change and helps to ensure the initiatives are successful.

Vanessa Marlowe suggested, “the on-site scheduler performance indicates advances over the last year and half, with significant growth during Q3 of 2022.” Marlow recognized that during this period, “at least 55% had agreed to a follow up appointment and of the 55% follow-up patients, 70% were able to get in during the 14-day, follow-up timeframe.”

The leaders of Vanderbilt’s Patient Access Services are enthusiastic that the pilot has turned into a successful venture. Marlowe expressed, “while initiatives began with neurology, vascular and COPD, other departments, such as primary care, are now eager to partner with them and grow their follow-up care initiatives.” Additional staff members and volunteers have offered to assist with on-site scheduling as well. With an embedded hospital scheduler, the practices in place at Vanderbilt support the steps necessary for a successful outcome in follow-up scheduling and post-discharge care.