NYU Langone Health

NYU Langone Health is a large academic medical center in the heart of Manhattan with six inpatient locations across the entire New York City area. With the mission to serve, teach, and discover, NYU Langone stands at the frontier of clinical medicine and basic science research with an emphasis on promoting clinical excellence and reducing healthcare disparities.

Discharge Virtual Visits

Discharge Virtual Visits built trust by reinventing the care transition process for hospitalized patients, in order to build continuity between patients and inpatient providers and establish a safe transition to an outpatient network. How does this build trustworthiness? The essential elements of trust – caring and competence – were provided to discharged patients through telehealth follow-up visits with the physicians who cared for them during their hospitalization, and care team members helped solve any identified problems.

How It Works

This practice aims to reinvent the care transition process for hospitalized patients to build more trust and continuity between patients and inpatient providers as well as to establish a safe transition to an outpatient network (either new or previously established). Many patients feel their clinical support network vanishes when they leave the hospital as there are often no reliable ways to contact the discharging medical team. Additionally, patients sometimes feel like inpatient providers abandon their responsibility to them once they leave the hospital.

With this practice, all patients discharged home are scheduled for a follow-up visit with the same physicians that cared for them during their hospitalization. If the patients have a telecapable device, they are enrolled in MyChart and scheduled for a virtual video visit. If they do not have a telecapable device, they are scheduled for a telephone call.

These virtual visits/calls occur within 2 days of discharge from the hospital. These do not take the place of their normally scheduled primary care provider follow up in 7-10 days after discharge.

Both the attending hospitalist and senior resident on the team hold these visits with their previously discharged patients on select days of the week. On the call, the providers assess for clinical symptoms, understanding of medications, and any issues with home services or medical equipment setup. A workflow for involving the appropriate team members to solve any identified problems has been established with the help of care management, social work, pharmacy, and the patient experience team.

Often the most challenging part of a patient’s hospitalization is the transition home. Utilizing the established rapport of patients with their inpatient providers, these visits make sure no issues arise during the transition.

Skills and Competencies

The practice of the discharge virtual clinic requires the refinement of telehealth skills, an understanding of clinical triage, and an awareness of non-clinical issues needing escalation for patient success.

We have built an extensive education curriculum for physicians (hospitalists and housestaff trainees) in order to refine these virtual health skills. We have constructed an escalation workflow for all non-clinical issues to help aid providers in getting their patients the assistance they need once at home.

Arguably, the most important skill underlining all of these competencies is the ability to communicate effectively with patients regarding their health, medications, and care at home.

Origins

Our medical unit wanted to improve our efforts around patient education, the safety of care transitions, and the establishment of appropriate outpatient follow up for patients to continue their medical care. Additionally, we wanted to form more rapport, continuity, and trust with our inpatient physicians and their patients even after discharge.

This practice platform ensures appropriate outpatient follow up. For those patients with an established primary care provider, we schedule a discharge follow up in 7-10 days. For those patients without a provider, we set them up to be seen in 7-10 days.

In addition to establishing follow up, we wanted to make sure all of our intended services, medications, and clinical care were appropriately established when the patient gets home. Seeing the same physician responsible for coordinating care in the hospital builds a sense of trust with patients so they don’t feel isolated and helpless if there are issues once at home.

Effectiveness

During our pilot phase over the last 3 months, we have seen improvement in our unit’s patient satisfaction scores around care transition, communication with doctors, and discharge information.

Anecdotally, our patients (and many times their caregivers) are excited to participate as they are often nervous about the transition home. We have scheduled almost over 100 virtual or phone visits. We have counseled patients on medications, educated them on care at home, addressed prescription issues with pharmacy, identified failed deliveries of medical equipment, and handled patient relation issues from the hospital stay.

Additionally, the housestaff physicians have found the activity rewarding and have often made key changes to their own discharge process to help improve patient education.

As our numbers grow when we scale to other units, we will be more in a position to study the effects on patient satisfaction and readmission rates.

Scalability

Yes, this practice is scalable. We have designed a scheduling, escalation, and physician workflow for this to be effectively introduced to different general medicine inpatient units. Additionally, this could be scalable and effective on surgical units as they face many of the same challenges in trust around care transitions on discharge.