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2226 Standardized Communication Tool Improves Inpatient-Outpatient Care Transitions for Adults with Acute LeukemiaClinically Relevant Abstract

Program: Oral and Poster Abstracts
Session: 903. Health Services and Quality–Myeloid Malignancies: Poster I
Hematology Disease Topics & Pathways:
Clinical Practice (Health Services and Quality)
Saturday, December 10, 2022, 5:30 PM-7:30 PM

Jordan R Hanrahan, DO1, Leroy J. Seymour, MD, MSc1*, Anna Beckius1*, Donna Welter1*, Mandy Kastner, MPH1*, Valarie Ehrlich, PA-C2*, Kristine Broge-Reynen, MS, APNP, ANP-BC2*, Mary Rodgers, MSN, AGNP, RN2*, Laura C. Michaelis, MD3, Lyndsey Runaas, MD2*, Ehab L. Atallah, MD2, Sameem Abedin, MD4, Guru Subramanian Guru Murthy, MD5*, Ravi Kishore Narra, MD, MS2, Mary Fournogerakis, BSN, RN, OCN6*, Jessica Schmitz, BSN, RN6*, Andrea Viitala, BSN, RN6*, Elizabeth Larsen, BSN, RN, OCN6*, Amber Essenmacher, PA-C7*, Gina George, PA-C2*, Kim Johnston, PA-C2*, Karen Sue Carlson, MD, PhD2,8* and Nicole Held, DO9

1Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
2Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
3Division of Hematology/Oncology, Department of Medicine, The Medical College of Wisconsin Inc., Milwaukee, WI
4Blood & Marrow Transplantation and Cellular Therapy Program, Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
5Medical College of Wisconsin, Milwaukee, WI
6Froedtert & the Medical College of Wisconsin Froedtert Hospital, Milwaukee, WI
7Incyte Corporation, Milwaukee, WI
8Versiti Blood Research Institute, Milwaukee, WI
9Division of Hematology/Oncology, Medical College of Wisconsin, Wauwatosa, WI

Background: Management of adults with acute leukemia involves frequent transitions between high acuity inpatient and intensive outpatient clinical settings. While clinical handoffs between inpatient team members are well-studied, little is known about the optimal means and clinical impact of inpatient-to-outpatient handoffs. The aim of our study was to develop a standardized discharge communication tool using the electronic medical record (EMR). We hypothesized that improvement in consistent inpatient-to-outpatient handoffs at our institution would lead to improved clinical care of adults with acute leukemia.

Methods: This project was performed as a quality improvement initiative at The Medical College of Wisconsin and its associated tertiary care hospital, Froedtert Hospital, between November 2020 and April 2022. Survey data was collected from inpatient and outpatient leukemia team members and was utilized to create a standardized communication tool and discharge process that was implemented in May 2021. Team members included physicians (attending, fellow, and resident physicians), advanced practice providers (APPs), and outpatient nursing and scheduling staff. The communication tool was sent by the inpatient team via EMR in-basket messaging approximately 48 hours prior to discharge. Included topics covered anticipated discharge date, types and timing of appointments needed, hospital complications, and results and tasks requiring follow-up. EMR data was collected for all discharged patients from the acute leukemia service including discharge date, follow-up appointments, and compliance with the communication tool. Patients were excluded if they were deceased prior to follow-up or discharged to hospice. 30-day readmission data was obtained from Vizient, and charts were reviewed to identify the primary reason for readmission. A follow-up survey was conducted 9 months after the tool was deployed to assess perceived changes in communication. Primary outcomes included rate of appointments scheduled prior to discharge, adherence with use of communication tool, and perceived success of the communication tool. Secondary outcomes included 30-day unplanned readmission rate and satisfaction with use of the communication tool. Significance testing was performed utilizing Chi-square testing for discrete variables and Mann-Whitney U-test for continuous variables.

Results: There were 755 total discharges between November 2020 and April 2022 from the acute leukemia service: 242 (32%) in the pre-intervention group and 513 (68%) in the post-intervention group (Table 1). Compliance with use of the communication tool occurred in 70% of cases. Overall, the percentage of scheduled follow-up clinic visits remained stable between groups (89% vs. 89%), but appointments scheduled prior to discharge significantly increased from 34% to 45% (p=0.007). The percentage of total infusion visits significantly decreased in the post-intervention group (81% vs 72%, p=0.004), but there was a significant increase in those scheduled before discharge (20% vs 33%, p=0.001) (Table 1). Perceptions of communication (strongly agree + somewhat agree) significantly increased regarding timely communication, outpatient staff members being informed of clinical plans, appointments scheduled prior to discharge, and correct appointment types being made (Table 2). There was a non-significant increase in in perceived sufficient communication between teams (Table 2).

The 30-day readmission rate decreased from 23% to 16% after implementation of the communication tool (p=0.017) (Table 1). The most common reasons for readmission between November 2020 and April 2022 were neutropenic fever (n=41, 29.1%) and infection not including neutropenic fever (n=21, 15%). Other reasons for readmission included respiratory complaints (n=15, 11%) gastrointestinal complaints (n=14, 10%), and neurologic complaints (n=13, 9%,). Cytopenia, oncologic reasons (treatment or transfusion reactions), and weakness/falls followed for a combined 15% (n=22).

Conclusion: Implementation of a standardized discharge communication tool was associated with increased follow-up scheduled prior to discharge, perceived communication between inpatient and outpatient teams and decreased 30-day unplanned readmission rates.

Disclosures: Michaelis: Sierra Oncology: Membership on an entity's Board of Directors or advisory committees, Other: Consulting, Advisory Board Meeting; Celgene Corporation: Membership on an entity's Board of Directors or advisory committees, Other: Consulting, Advisory Board Meeting; Abbvie: Consultancy, Other: Consulting, Advisory Board Meeting; Jazz Pharmaceuticals: Other: Funding for Research Study to my Institution; Incyte Corporation: Consultancy. Runaas: Servier: Honoraria. Atallah: Novartis: Consultancy, Research Funding; BMS: Consultancy, Speakers Bureau; Takeda: Research Funding; Abbvie: Consultancy, Research Funding, Speakers Bureau; Blueprint: Speakers Bureau; Servier: Consultancy. Abedin: Amgen: Honoraria; Stemline: Honoraria; AltruBio Inc.: Research Funding; Helsinn Healthcare: Research Funding; Pfizer: Research Funding; Actinium Pharmaceuticals: Research Funding; Incyte: Research Funding; AbbVie: Honoraria; Daichi Sankyo: Honoraria; Servier: Honoraria. Essenmacher: Incyte Corp.: Current Employment.

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